Caring for those with advanced illness comes with its own set of unique barriers, says Dr. Joseph Agostini, senior medical director of Aetna Medicare, in discussing the Aetna Compassionate Care Program. Primary among them is determining a diagnosis treatment plan, given the lack of awareness of what the patient was suffering from prior to their arrival in the program, and the lack of consensus about how the family wants to proceed.
Case managers and staff within the Aetna Compassionate Care Program run into barriers, and they’re barriers that affect all of us who are trying to improve the quality of care for those with advanced illness. The first barrier has to do with patients who have been inadequately treated for pain and symptoms, and who don’t completely understand their care options, given their lack of experience with resources in the community and the hospital, or through other means. Many of them lack emotional support, and here’s where the case manager can play a great role in providing caring, responsive and emotionally supportive services to an individual patient who is going through obviously difficult circumstances.
Secondly, we also have issues around late referral in the community; we try to identify patients and members early, but as we all know, there has been historically a lag in the number of patients who fully access and use palliative care and hospice services, although that is gradually beginning to change right now.
And finally, difficulties in determining prognosis are sometimes barriers because patients and families don’t always engage in discussions around advanced directives and shared decision-making around goals with their physicians if it’s not clear what the prognosis actually is for a particular condition.
Case Management for Advanced Illness: Best Practices in End-of-Life Care
Case Management for Advanced Illness: Best Practices in End-of-Life Care presents two advanced care leaders’ thoughts on the best practices and barriers that often arise with this population, the tools and resources that can contribute to their higher quality of care, and effective patient engagement techniques, among other things.