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How GBMC’s advance care planning saves families stress in end-of-life decision making

By:

Korey Karnes Huyler for Greater Baltimore Medical Center

September 18, 2020
COVID-19 has forced many Baltimore residents to think about things they probably never thought of before: “Am I washing my hands the right way?” “How many times a day do I really touch my face?” “Where did that cough come from?”

But one of the newest things many of us have been considering since March is a lot more serious: “What will happen if I am alone in the hospital at the end of my life?”

In some cases, patients sick with COVID-19 faced unexpected end-of-life decision making with only virtual communication with their families. This heartbreaking reality makes it clearer than ever before that everyone needs an end-of-life plan before they get too sick — not just elderly people.

WHAT’S THE SOLUTION?
Even in normal times there is nothing easy about making end-of-life decisions for yourself or a loved one. That’s why the Greater Baltimore Medical Center has a dedicated department that deals with Advance Care Planning. Dr. Delia Chiaramonte and her team manage integrative care, palliative medicine, living wills and more at GBMC.

“I am the medical director of integrative and palliative medicine at GBMC,” Dr. Chiaramonte explains. “In that role I lead a team of other palliative care providers, and we help patients who are admitted to the hospital with their advance care planning needs — things like determining their goals of care, making decisions about cardiopulmonary resuscitation, helping patients with symptom management and coping with serious illness.”

Dr. Chiaramonte works alongside Dr. Robin Motter-Mast, GBMC HealthCare’s new chief of staff, who has been working on advance care planning for younger GBMC patients for the last few years. Dr. Motter-Mast is leading the push to have every GBMC patient over the age of 18 fill out a healthcare agent form during their annual physical.

“Patients can determine who they want to make their end-of-life decisions if they are unable to,” Dr. Motter-Mast explains. “We help them normalize the conversation, then they go home and talk about their decisions with their family. They can have upfront communication about who is truly making the decisions if something happens to them.”

Dr. Motter-Mast explains that once a patient chooses their healthcare decision-maker, the information is entered into GBMC’s electronic medical records system, Epic. Patients can change their decision anytime they want.

Dr. Chiaramonte also stresses the importance of picking your healthcare decision-maker and having an advance directive — though she admits there is a lot to think about.

“Everyone over the age of 18 should have an advance directive,” Chiaramonte explains. “An advance directive has two parts: the determination of a medical power of attorney (MPOA) and a living will. The MPOA, also known as the healthcare agent, is the person that you would want to speak for you to the doctors and make medical decisions for you if you were unable to make them for yourself. This should be someone who you trust to make the decisions that you would want, even if they are different than what they would want. The living will component of the advance directive explains what you want if you were very ill, near the end of life or in a persistent vegetative state and not expected to recover.“

Both doctors stress the importance of having these end-of-life decisions made before anything happens to you — for your own end-of-life experience and your family’s.

“It’s a waste of time and money to be arguing about who is making the decisions when Mom is already sick,” Dr. Motter-Mast explains. “When you’re spending time arguing amongst family about Mom, it costs a lot, and you are wasting valuable time, which should be focused on your loved one. It’s important for people to take the initiative now, make their plan and lay it out for their family.”

WHAT ABOUT OLDER PATIENTS?
While GBMC is working to have younger, healthier people make these decisions early in life, the hospital does the same with older patients who are nearer to the end-of-life experience.

“At GBMC we have an in-house palliative care team and we are often consulted to see patients who are facing serious medical illness,” says Dr. Chiaramonte. “In addition to helping with medical decision-making and advance care planning, we help patients with symptom management and coping. Our team has physicians, nurse practitioners, a social worker and a mind-body specialist to help patients manage their stress and anxiety. We collaborate closely with the primary medical team.”

For more information about advance care planning at the Greater Baltimore Medical Center, visit www.gbmc.org/advance-care-planning.
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