The Arc of Conversation: A How-to Guide for Goals of Care Conversations, to be published soon by Springer Nature

Now available for preorder on Amazon and Barnes & Noble!

Intending to fill an important gap in medical training, this book presents an easy-to-learn, standardized approach to having compassionate and collaborative goals of care conversations with patients and families, a skill that can be difficult for clinicians to learn and that is not part of standard medical education curricula.

Developed by a Palliative Care provider, this is the first book to teach everything clinicians need to know to gently guide patients and families through what can often be difficult discussions about illness, disease, end-of-life wishes, and hospice care. This technique can be used to discuss any medical diagnosis or treatment, be employed at any age or stage of an illness, and can be used by health care professionals at any level.

Readers will be introduced to the patterns of decline patients follow toward the end of life, criteria for recognizing when a patient’s time is limited, hospice care, ground rules for compassionate communication, and a step-wise method of leading patients and families through difficult goals of care conversations in a collaborative way. The book includes specific questions to ask and starter language clinicians can use for developing their own patient-friendly talking points about disease progression, the end of life, concerns that a patient’s time is limited, advanced directives, code status, and hospice care. An Arc of Conversation Guide, for use when learning this technique, is also included.

While modern medicine is terrific at acute stabilization of illness or injury, it often ignores the elephant in the room—disease progression and death. By doing so, the healthcare system frequently misses opportunities to align patient wishes with the care they receive. Furthermore, physicians often avoid difficult conversations with patients due to a lack of training or the assumption that hospice care represents medical or personal failure. Incorporating the material and technique taught in The Arc of Conversation into everyday practice will enable clinicians to acknowledge and discuss patient decline and to confidently include hospice care as a viable option for treatment that can support patient values, wishes, and priorities. Moving toward a continually collaborative approach with patients—a shift away from physician-directed care to patient-centered care—will enable clinicians to develop treatment plans that prioritize outcomes that matter most to patients and families, improving patient and family experience of health care across their lives and providing patients with the ‘soft landing’ they want at the end.

Compassionate Collaborative Care, Strategic Initiative, 2021

While working at Cheyenne Regional Medical Center, I researched and developed a new role for healthcare leadership, Director of Compassionate Collaborative Care, to build into the medical system the compassionate and collaborative approach that has been the hallmark of my work for patients and families. Click here to read my initiative.

The Compassionate Collaborative Care (Triple C) model aims to better align patient wishes with care while providing substantial cost savings. By transitioning patients away from unwanted and costly interventions at the end of life and aligning patient wishes with care, the initiative can help reduce overall healthcare costs. The new Alzheimer’s and Dementia Care Program at CRMC demonstrates the success of this model, as patient wishes for a 'soft landing' at the end of life are aligned with lower-cost care. Overall, adopting the Triple C strategy system-wide is necessary to transform the focus of care at every step of a patient’s journey and at every touch point with the healthcare system, ultimately providing value-based care and reducing unnecessary costs.

Palliative Care Has a Branding Problem, MedPage Today, Feb 2024

This article discusses the need for greater access to palliative care for patients and families dealing with chronic and terminal diseases. It emphasizes the importance of addressing the personal impact of illness on individuals and their families, highlighting the role of palliative care in providing holistic support. The article also advocates for a rebranding of palliative care to help healthcare professionals better understand its benefits. Additionally, it calls for a shift towards "Compassionate Collaborative Care" to embed palliative care throughout the healthcare system, providing continual support from diagnosis onwards.

Wyoming PBS: "A State of Mind, The Caregivers," May 2024

I recently had the opportunity to be featured in a Wyoming PBS episode of the Emmy award-winning series "A State of Mind: The Caregivers," which focused on the challenges of being a caregiver for a loved one with dementia. The program shed light on the immense responsibility that comes with caregiving and highlighted the mental health challenges that caregivers often face, such as depression, anxiety, and loneliness. It also emphasized the growing population of caregivers and the importance of not overlooking their mental well-being. The special provided a platform for caregivers to share their experiences and offered valuable insights into how we can better support and care for those who take on this crucial role. It was an honor to be part of such an important and impactful project.