Aligning care with patient values, one conversation at a time

Advanced Care Planning in Family Medicine

By Amber Hollingsworth | May 2022

Last summer, a team from OHSU Family Medicine launched a pilot program to study the impacts of clinicians having guided Advanced Care Planning conversations with patients. With ACP, people can designate the type of medical care they want to receive now and if they become unable to speak for themselves. One of the best places to have that conversation is in a primary care practice, where relationships are already established and continuity of care is paramount. 

“It's a fascinating project,” said Erin Gallivan, RN, the ACP Coordinator for this project. “It's so new to our patients – many of them haven’t been approached about these conversations, and they’re happy to share their life experience and their wishes.” 

The 3-year project is based out of the OHSU Family Medicine Gabriel Park Clinic, and is run by Sumathi Devarajan, MD; Eriko Onishi, MD; Harry Krulewitch, MD; Erin Gallivan, RN; Seiko Izumi, PhD, RN; and Suzanne Sullivan.  

The team’s main focus is introducing and using the Serious Illness Conversation Guide (developed by Ariadne Labs) with older and seriously ill patients during their regular PCP visits. The other component is training residents and faculty to have these conversations in their everyday practice, so that they’re not happening in a patient’s moment of crisis. The study will also track whether a patient’s end-of-life care matched their choices recorded in their chart. 

“So far patients have been very receptive to these discussions,” Gallivan said. “We’re getting a lot of new information about our patients, and they’re considering questions they’ve never been asked before. Family members are appreciative too – we’re able to start conversations they maybe didn’t know how to have.” 

Gallivan has been reaching out to patients to assess their interest in ACP, and having meetings with them and family members both in person and by phone. She’s also meeting virtually with people in care facilities. The study will also indicate whether a position like Gallivan’s – ACP Coordinator – is beneficial for clinics to be able to facilitate this work. 

These conversations aren’t just good for patients – Gallivan has been so touched by their openness. “People are taking time to reflect on their lives, and we get to hear their stories. It's exciting to be invited into this part of their lives.”  

This study is funded by an Innovations Grant from the Cambia Health Foundation – IRB# 23954.

Onishi HARP team

In September 2021, Dr. Onishi received a Hartford Award for Research and Practice to expand this work and increase the number of providers and learners who are trained in high quality ACP conversations. She's pictured here with Dr. Krulewitch, Dr. Izumi, and Dr. Devarajan.