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I have been a pediatric case manager with a health care plan for the last eight years. Telephonic management requires skills in counseling, negotiation, and communicating and coordination of the child’s care with multiple providers, vendors, physicians, specialists and parents. Parents require much time for counseling, education, resource guidance and checking their knowledge and compliance with treatment plans. Many parents must make difficult decisions regarding their children who have a catastrophic condition or terminal illness.
The health care plan provided a resource for the case management team called Vital Decisions, a totally covered benefit. Their Living Well Program assists members/surrogates who are seriously ill in making timely, informed decisions. The case manager’s task is to identify and refer members, through a website (www.vitaldecisions.net), who would most benefit from the intervention.
This unique patient-centered counseling enables patients and family members to impact the care planning process and achieve more desirable results under very challenging circumstances.
To start the process, the nurse case manager obtains the patient’s consent, provides patient address and phone number, diagnoses, physician contacts and the reason for referral. Following the counselor-patient/surrogate conversation, the counselor will provide a comprehensive case summary to the case manager by electronically forwarding the document to a “landing page.” This document will capture the essence of the discussion and goals of care. Updates are provided on a regular basis. Vital Decisions consults are with patients of all ages and are not only for terminal patients.
This has been an invaluable resource for empowering my patients/surrogates to become active decision makers. Some require multiple contacts and lengthy discussions. Vital Decisions will often contact the physician as well and recommend resources of which I was unaware. The parents will then choose the best course of treatment for their child.
The special collaboration between case managers and Vital Decisions counselors is crucial since most patients/surrogates do not recognize the need, have the knowledge, or possess the confidence to participate sufficiently in health care decisions to effectuate their preferences. In addition to creating better informed patients and family members, the consultation process assists nurse case managers with “stalled cases,” provides a “neutral resource,” covers labor-intensive cases, fills in the gaps between sites, and offers expertise in bioethics, health care law, and mediation skills while respecting cultural sensitivities, ethnicities and religious traditions. After the referral is received, patients and surrogates participate in a series of telephonic counseling sessions which focus on identifying goals of care, weighing the benefits and burdens of various care options using custom-tailored decision-making tools, and developing ways to better communicate with their physician to achieve optimal outcomes.
This unique patient-centered counseling enables patients and family members to impact the care planning process and achieve more desirable results under very challenging circumstances. It is the proactive collaboration between case managers and counselors that facilitates patient empowerment and drives the improvement in outcomes and the greater patient and family satisfaction during critical illness.
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