Frequently Asked Questions
Answers to frequently asked questions are below. To download or print FAQs, click here.
- What is Honoring Choices Wisconsin?
- Why is it important?
- What is advance care planning?
- Why is the Wisconsin Medical Society interested in advance care planning?
- What is the Wisconsin Medical Society asking health care systems to do?
- What do the pilots look like?
- What will community outreach look like?
- What are the consequences of this project?
- What is the Wisconsin Medical Society’s role in the project?
- How can we measure success?
- What does an effort like this cost?
- How can I start the conversation with my doctor, family and loved ones?
- Does this project require legislation?
- Does this program include POLST?
- How can I participate?
1. What is Honoring Choices Wisconsin?
Honoring Choices Wisconsin is a major initiative whose mission is to promote the benefits of and improve processes for advance care planning across the state, in health care settings and in the community.
Modeled after Honoring Choices Minnesota, a project of the Twin Cities Medical Society, and Respecting Choices® First Steps®, a pioneering program in advance care planning based in La Crosse, the Wisconsin Medical Society (Society) serves as a convener, coordinator and catalyst to build clinical pilot projects based on proven concepts, methodologies, training systems and materials, combined with outreach in communities across the state.2. Why is it important?
Starting a conversation about end-of-life care is difficult for all of us, whether we are physicians, patients, family members, religious and community leaders or other health care professionals. It is, however, imperative that these conversations happen. And once they occur, it is equally critical that patients’ choices are honored by those who care for them.3. What is advance care planning?
Advance care planning is a process across time of understanding, reflecting on and discussing future medical decisions, including end-of-life preferences. Advance care planning includes:
4. Why is the Wisconsin Medical Society (Society) interested in advance care planning?
- Understanding your health care treatment options.
- Clarifying your health care goals.
- Weighing your options about what kind of care and treatment you would want or not want.
- Making decisions about whether you want to appoint a health care agent and/or complete an advance directive.
- Communicating your wishes and sharing any documents with your family, friends, clergy, other advisors and physician and other health care professionals.
Wisconsin has had champions for advance care planning, hospice and palliative care for years. The Society’s Council on Ethics recognized, however, that advance care planning still is not the norm for physicians, patients and their families, and looked for ways to meet the enormous need for improvement. After viewing the documentary Consider the Conversation and learning of the Twin Cities model, the Council and the Society’s Board of Directors agreed such an effort is crucial to the health of the people of Wisconsin. In 2012, the House of Delegates formalized its support for the Society to take a lead role in the development and implementation of a statewide advance care planning initiative.5. What is the Wisconsin Medical Society (Society) asking health care systems to do?
The Society is building collaboration around facilitating advance care planning conversations and honoring patients’ decisions throughout care. To participate in the project, health systems agree to:
6. What do the pilots look like?
- A common emphasis on improving the conversation across health systems and communities throughout Wisconsin.
- A common advance directive form and other informational materials.
- Train staff in the Respecting Choices® First Steps® program.
- Devote organizational resources to a pilot project.
- Share lessons learned from their experiences formally and informally.
- Capture consistent quality measures.
- Shared community outreach under the umbrella of the advance care planning project.
- Contribute financially to the Honoring Choices Wisconsin initiative.
Honoring Choices Wisconsin coordinated six-month pilot projects in 13 sites across six organizations in Southeast and South Central Wisconsin, which began in March 2013. Participants provided facilitated advance care planning conversations to patients in a targeted demographic. The approach is based on the principles of Respecting Choices® First Steps®, a pioneering organization in advance care planning based in La Crosse, and participants and facilitators are trained by Respecting Choices® staff.
- Sites target a chosen demographic (e.g., patients 60 and older, patients with hypertension).
- Patients are offered a facilitated advance care planning conversation conducted by a nurse, social worker, chaplain, volunteer or other staff, under the guidance of a physician.
- Documentation of the conversation is entered consistently into electronic health records.
- Site leaders and facilitators are trained by Respecting Choices®. (Training and consultation for the first round of pilots began in September 2012, with facilitator trainings conducted in early 2013. Round 2 participants began training in Fall 2013.)
- Measurement metrics include the number of patients offered facilitations, number of conversations conducted and number of new advance directives entered into the medical record.
- Participants share lessons learned formally and informally, engage in monthly meetings and report findings.
The trial implementation provides participants the experience necessary to implement advance care planning systems across their organizations. The Society funds a substantial portion of the trainings; participation also requires internal costs, which vary depending on size and structure.7. What will Community Outreach look like?
After clinical implementation is under way, Honoring Choices Wisconsin will launch a major grassroots effort to reach Wisconsinites through media, multicultural organizations, senior centers, support networks and other venues. Community, religious, senior and other leaders will be engaged in this project from the beginning. It is particularly important to us that we reach Wisconsin’s underserved populations.8. What are the consequences of this project?
We believe this coordinated effort around advance care planning will result in:
9. What is the Wisconsin Medical Society’s (Society) role in the project?
- Improved understanding of advance care planning, hospice and palliative care among physicians, other health care professionals and patients.
- Higher advance directive completion rates.
- Significant improvement in end-of-life care.
- Fewer hospital readmissions and patient intensive care unit days and increased hospice utilization.
- Greater satisfaction among family members after the death of a loved one.
- Greater public awareness of and demand for advance care planning.
The Society serves as convener, coordinator and catalyst for Honoring Choices Wisconsin. To facilitate this approach, the Society:
10. How can we measure success?
- Engages physicians on the importance of advance care planning.
- Organizes design and implementation, facilitator and instructor training courses.
- Helps participants form pilot teams and develop their work flow.
- Provides a forum for information sharing.
- Drives community involvement and education.
- Publicizes the project and its participants.
In the short term, we can measure the number of patients offered facilitated conversations through the initiative, the number of conversations conducted and the number of new advance directives entered into the medical record. Over the long term, we can track increases in the number of conversations and advance directives completed across the health care system, the number of days patients spend in the hospital, intensive care unit and hospice in their last days of life, and satisfaction and depression rates among family members after the death of a loved one.11. What does an effort like this cost?
An effort of this magnitude requires significant resources: $400,000 for training, staff and outreach in its second year. Grassroots community and media efforts, once launched, will require additional resources in future years.12. How can I start the conversation with my doctor, family and loved ones?
Starting the conversation can be difficult, and the Wisconsin Medical Society hopes to help people across the state have the courage and ability to speak with their family members and health care professionals. For tips and resources to help you get the conversation going, visit www.HonoringChoices.org.13. Does this project require legislation?
No. Although many agree there is room for improvement in Wisconsin’s advance care planning law, we believe that the state’s health care system can make dramatic improvements to advance care planning without new legislation or government intervention.14. Does this program include POLST?
No. The POLST (Physician Orders for Life-Sustaining Treatment) form is an end-of-life effort that attempts to document and honor patients’ decisions as they approach their last days. Honoring Choices Wisconsin is focused on the “upstream” advance care planning conversations that nearly all adults can have.15. How can I participate?
Making a project like this work will require participation and contributions from physicians, hospitals, nurses, community groups, multicultural organizations, clergy, health care workers, senior centers, the media, business, and everyone else. Learn more at our Honoring Choices Wisconsin and by subscribing to our newsletter.
Please contact Honoring Choices Wisconsin at firstname.lastname@example.org to learn more about what you and your organization can do to participate.
The name “Honoring Choices Wisconsin” is used under license from the Twin Cities Medical Society Foundation.
RESPECTING CHOICES® is a registered mark used under license from Gundersen Lutheran Medical Foundation, Inc.