One of the Quality Institute’s most innovative and exciting initiatives is Conversation of a Lifetime, a part of our Mayors Wellness Campaign. I’ve asked our Director of Community Health, Janan Dave, to take over my blog today to report on this effort. Janan has been engaging New Jersey mayors to encourage important end-of-life discussions among their constituents. Janan has made great progress leading this significant effort.
Every one of us has easy access to a very powerful medical tool. This tool does not require a doctor or a prescription. You don’t need health insurance or a $1 million medical imaging machine to use it.
This tool, one of our very oldest, can save you from painful interventions that may not prolong your life but even worsen the circumstances of how you die. It can save a family from tremendous unnecessary stress and confusion during a time that should be devoted to love, comfort, and care.
This tool is called a conversation. At the Quality Institute, we have launched a campaign, called “Conversation of a Lifetime,” to promote community discussions around advanced care planning. Simply documenting your wishes and telling your loved ones what is important to you at the end of life can give you and your family control and peace in your final days.
The effort, which receives generous support from the Horizon Foundation for New Jersey, is launched through our Mayors Wellness Campaign because we believe that advance directives are not just medical issues. These are community and cultural issues. Our towns and cities can create environments that advance these discussions and truly help residents.
Yes, I have heard from mayors who ask me why they should be involved. After all, this isn’t exactly the kind of topic they normally focus on.
But in my discussions with mayors I find many understand they can be agents of change. Mayor David R. Mayer of Gloucester said he learned about end-of-life care and hospice when his own mother passed away. “We can all benefit from education. We owe it to our loved ones to have these conversations,” he said.
And the mayor of Tenafly, Peter Rustin, said at first he did not see the connection to the Mayors Wellness Campaign. Then he realized that if these issues were difficult for him to confront, they were probably also difficult for his residents to deal with, which was all the more reason for him to take on such a project.
Gloucester Township and Tenafly are two of three municipalities selected to launch “Conversation of a Lifetime.” The other is Princeton, where Mayor Liz Lempert told a reporter: “Because it’s a difficult conversation, this is really what a community is for: to help each other to address difficult topics.”
Our campaign comes at an opportune time. Medicare recently announced that doctors will be reimbursed for the conversations they have with patients about their wishes should they become too sick to communicate for themselves. We know that reimbursement is only one piece of the puzzle, but it’s a tremendous step in the right direction. Reimbursement from Medicare is an acknowledgement that these conversations are worthy of doctors’ and patients’ time.
In each town, I work with the Mayors and a local task force of community leaders—librarians, clergy, hospice nurses, physicians, lawyers, and others—to plan a calendar of programming. We will have screenings of movies such as “The Bucket List” and “Still Alice.” There will be seminars and book discussions, as well as educational events with elder lawyers and health professionals. You can find more about these events by clicking here.
We are very excited about our book discussions of “The Conversation: A Revolutionary Plan for End-Of-Life Care” by Angelo E. Volandes, M.D., who will visit New Jersey in November. As Dr. Volandes writes in his book, “Without this open conversation about death, patients are traumatized needlessly, leaving their families with the emotional scars of witnessing the hyper-medicalized deaths of their loved ones. “
Dr. Volandes argues for a radical re-envisioning of the patient-doctor relationship to ensure patients are at the center of and control their medical care.
And anyone who cares about these issues also should read Atul Gawande’s book, “Being Mortal.”
Dr. Gawande writes about the death of his father. He knows what questions to ask the surgeon who wants to operate immediately — as well as the oncologist who wants to start chemotherapy.
At the Quality Institute, we are just beginning with this campaign. We hope one day that talking about what we want in our final days will be as easy as talking about what we want from the grocery store. That’s an ambitious—but worthy—goal.
Please let me know how our campaign can help your community or, better yet, let me know your thoughts on how you think we can strengthen our efforts to encourage more people to have the Conversation of a Lifetime.