Outpatient FAQ
General
What is the Jumpstart Program?
The Jumpstart Program is a quality improvement program using one-page “Jumpstart” guides to increase the occurrence and quality of goals-of-care discussions between clinicians and patients with chronic, life-limiting illness including dementia and memory problems. The goal of the Jumpstart Guide is to encourage a goals-of-care discussion when appropriate as well as the documentation of the discussion in the electronic health record. We are evaluating the Jumpstart Guide in a series of randomized trials. The current study is funded by the National Institute of Aging.
How do you define a goals-of-care discussion?
Goals-of-care discussions are defined as ‘planning for medical care that may happen in the future if the patient becomes sicker.’ The conversation normally occurs between a clinician and the patient and/or the patient’s surrogate decision-maker to identify the patient’s values and goals and the overarching aims of medical care for the patient. These discussions can include decisions about using or limiting certain medical interventions, worsening of disease, or end-of-life care.
Where has the Jumpstart program been operating?
The Jumpstart Program has been operating in the inpatient setting at Harborview, UW Medical Center–Montlake and UW Medical Center – Northwest. We are now expanding the program to UW outpatient clinics at Harborview, Montlake, and UW neighborhood clinics. Jumpstarts delivered to providers in the outpatient setting are focused on patients with dementia or memory problems.
I have questions about how to best conduct a goals-of-care discussion.
Dr. Susan Merel conducts a series of educational programs on goals-of-care discussions and has also created a handout with guidance on starting these conversations: Goals of Care Conversations: Why, When, How.
Please also see the “resources” tab above for links to further reading and support for goals-of-care discussions with patients with dementia and their family members.
I have questions or concerns, who can I contact?
Study PI: Dr. Erin Kross / 206.744.4649 / ekross@uw.edu
Research coordinators: Janaki Torrence / 206.710.4916 / jtorrenc@uw.edu; Anna Ungar / 206.537.6248 / amu@uw.edu
If you have questions or concerns about a specific patient, you may also respond directly to the Jumpstart Guide email. Finally, you can direct any inquiries to uwjumpstart@uw.edu and we will be in touch.
Enrollment and Logistics
How does the study work?
Potentially eligible patients who have an upcoming clinic visit are identified through a review of the electronic health record. A Jumpstart Guide will be sent to the clinician 2-3 days before this visit via email. The Jumpstart Guide has information about the patient’s current advance care planning documents in the EHR, as well as tips for having a goals-of-care discussion. Clinicians will receive a reminder about the Jumpstart Guide on the day of the patient’s visit via Epic SecureChat.
Patients and/or their surrogate will be invited to complete questionnaires about their care experience at one, three and twelve months after the visit.
Which patients are eligible?
Patients age 55+ years who are being seen as an outpatient at a UW Medicine clinic, have an ICD-10 code for ADRD documented in the EHR within the prior two years.
Who is sending me an email and why?
A research coordinator will send you a Jumpstart Guide via email if you have an upcoming appointment with a patient who is eligible for our study and may be appropriate for a goals-of-care discussion. You will receive the email 2-3 days prior to the patient’s appointment with you.
Is the Jumpstart Guide in the patient’s chart?
Jumpstart Guides are not automatically available in the patient’s chart but you can use the SmartText “JUMPSTART” to see the Jumpstart Guide within an encounter note.
Where can I find the documents noted at the top of the Jumpstart Guide (advance directive, POLST, durable power of attorney)?
We use automated methods to determine whether these documents exist within the EHR. You can find them in Epic under the patient’s demographics, where there are tabs for both Advance Directives (POLST and DPOA-HC are included here) and Code Status.
What do I need to do after I have the goals-of-care conversation?
Document the conversation in the electronic health record as you normally would- no need to follow-up with the study team. Consider including a few of the patient’s or surrogate’s words in your documentation.
Do I have to address everything on the Jumpstart?
No! Pick the topics you feel are best suited for this patient.
Does my patient need to sign a consent form?
You do not have to ask the patient and/or family member to sign anything for this study. If the patient and/or family member decides to complete follow-up questionnaires after the clinic visit, a research coordinator will complete the consent process.
What if I don’t want the research team approaching my patient(s) about participation?
The research team will always send an email to the patient’s physician prior to the patient’s visit. If you don’t think it is appropriate to approach your patient, please email us to let us know.
What if I don’t have time to talk with the patient about goals-of-care?
We know clinicians can be very busy, but we hope you’ll be able to make time for a short goals-of-care conversation.
Clinician Appropriateness
Can one of my other team members have the goals-of-care discussion with the patient?
Yes! Feel free to share the Jumpstart Guide with any clinicians who would be appropriate for having a goals-of-care discussion with the patient.
What if I am not the patient’s primary doctor and think the patient should have this conversation with their primary doctor instead of me?
We understand sometimes goals-of-care discussions may be more appropriate for the patient to have with their primary doctor, but still encourage you to consider if the patient could benefit from a goals-of-care discussion with you.
What if the patient is scheduled to see a geriatrician or palliative care doctor, should I still have a goals-of-care discussion with them?
We leave it up to you to decide if you feel that a goals of care discussion might be helpful in guiding the care you are able to provide your patient.
What if this isn’t my patient?
If you feel you received the Jumpstart Guide in error, please let the study team know by emailing us at uwjumpstart@uw.edu.
Patient Appropriateness
Do I have to have a goals-of-care conversation with this patient?
No. If you feel it is inappropriate to have goals-of-care with your patient at this time or you are unable to have goals-of-care for some other reason, that is ok. We understand that these discussions aren’t always appropriate or possible.
What if my patient doesn’t have decisional capacity, can I have this conversation with their family?
Yes!
What if my patient doesn’t have decisional capacity and there is no family available?
If we contact you about a potentially eligible patient who does not have decisional capacity and does not have an available family or surrogate decision-maker, we would appreciate it if you would let us know by secure chat, phone, or email.
What if my patient isn’t that sick or near end of life, should I still have a goals-of-care discussion?
Yes! The Jumpstart program is promoting early goals-of-care discussions for patients with chronic illness, even if they are relatively healthy.
I already discussed code status with the patient, why am I getting the Jumpstart Guide?
Discussing code status is a great start! We encourage you to further explore other components of goals-of-care, such as discussing the patient’s values and goals, assessing health states or treatments the patient would not find acceptable, and – when appropriate – helping the patient fill out a durable attorney for healthcare or a POLST.
What if my patient is DNR/DNI, should I still have a goals-of-care discussion?
Often, yes! Prompting goals-of-care conversations is not only about code status, but also about the treatments that are best aligned with the patient’s values and goals. You may also discuss with the patient acceptable health states and treatments, and – when appropriate – help the patient fill out a durable attorney for healthcare or a POLST.
What if I already had an extensive goals-of-care discussion with the patient?
That’s great! We try to exclude patients from the study who have already had goals-of-care discussions, but sometimes we miss these conversations. Make sure to document your goals-of-care discussions in the electronic health record.
What if my patient is a cancer patient, shouldn’t they have this conversation with their outpatient oncologist?
We encourage you to consider if the patient would benefit from a goals-of-care discussionwith you.