TPOPP Initiative Charter is a Community Conversation Initiative sponsored by TPOPP Initiative Partners: Via Christi Health, Wesley Medical Center and the Medical Society of Sedgwick County.
TPOPP Initiative Partners recognize and respect the value of approaching the end of life with a physician order set that starts with a talk among the patient, family members or loved ones and the physician and members of the health care team. TPOPP is discussed in private with a patient facing chronic advanced illness or terminal illness as a tool for end of life planning. The intent is to change the culture in Wichita, KS to embrace a proactive approach to end of life planning and dying with dignity.
TPOPP is modeled on the Physician Orders for Life Sustaining Treatment (POLST) paradigm, one of more than 30 such efforts currently underway nationally to address these important issues. The Center for Practical Bioethics in Kansas City, MO is promoting a bi-state TPOPP Coalition in Kansas and Missouri. The Center for Practical Bioethics is coordinating the TPOPP Initiative with training, monitoring and evaluation tools.
A Wichita TPOPP Steering Committee began in spring 2012 when health care leaders gathered to explore the TPOPP Initiative. A pilot study was conducted in Topeka during 2010 and 2011. Sandy Silva, JD is the TPOPP Program Director of the Center for Practical Bioethics’ TPOPP Initiative.
TPOPP is based on the belief individuals have the right to make their own health care decisions. In Wichita-Sedgwick County, TPOPP Initiative Partners are partnering to promote the conversation and implementation of the TPOPP form.
The TPOPP Initiative Partners recognize and respect the value of approaching the end of life with a “plan” that has been discussed in private with a patient facing a chronic advanced or terminal illness, their loved ones and a trusted physician.
The TPOPP Initiative Partners believe greater awareness of end of life planning can reduce the emotional toll which occurs when medical solutions are no longer available or viable. This emotional toll is even greater when end of life plans have not been communicated.
The TPOPP Partners pledge to work collaboratively to promote a “community conversation” that will result in an increased level of awareness of the value of end of life planning.
The TPOPP Initiative aims to improve the communication of a person’s preferences regarding life-sustaining treatments and help generate better medical care.
TPOPP is designed to:
- Document a person’s treatment preferences regarding CPR and the use of mechanical intervention for breathing/ventilation along with other life-sustaining treatments, such as tube feedings, dialysis, etc.
- Define a patient’s preferences into an actionable portable set of physician orders.
- Communicate an individual’s care preferences across all health care settings.
- Reduce repetitive documentation while complying with state laws and the Federal Patient Self-Determination Act.
Prior to disseminating TPOPP forms, the TPOPP Initiative Steering Committee will work collaboratively with community health care providers to promote awareness and utilization of the TPOPP protocol. Community health care providers will include physicians, nurses, hospital-based providers including ED staff, long-term care providers, hospice providers, home health providers and first-responders, such as EMS and fire department. The Steering Committee will also engage in discourse with the general population, Wichita community through a variety of means: media, civic groups, churches, etc.
Timeline of strategies
Each of the hospitals will identify a working team to obtain medical executive approval and then move TPOPP through the administrative process. This may take 3-6 months depending on committee meeting times and sequencing of steps at each institution. Also, hospital administration and training teams will decide which providers and staff member will be initially trained. Then, TPOPP Steering Committee members can begin introductory sessions to inform hospital staff that TPOPP is coming, what TPOPP is and who will discuss the form with the patient and/or family.
During this 3-6 month period, the hospitals also will provide names of target partner facilities to the TPOPP Steering Committee. The long-term care facilities also will obtain approval within their organizations and determine how they will incorporate TPOPP into their policies and procedures. The process will start with information sessions to create awareness and then launch full-fledged ‘training’ in the use of TPOPP.
Community conversations about end of life planning
Ask any practicing physician, nurse, or hospital chaplain and they’ll confirm that we have a long way to go when it comes to approaching the end of our lives with any sense of planning or preparation. It’s an event each and every one of us will face someday. Some of us have done the hard work ahead of time and approach the phase with a sense of comfort and peace. Others of us – not so much…
As representatives of the Wichita physician and hospital community we see a need for our community to have a deeper, richer conversation about end of life planning. Unfortunately, we witness on a daily basis the consequences when a family member with a terminal or serious illness reaches the end of our ability to heal or restore and there hasn’t been that important, private conversation. While medical technology has progressed to the point that we can keep virtually any body “alive,” we frequently avoid asking the question “when is enough — enough?” We believe that a private, honest conversation between the patient, close loved ones, and a trusted physician will allow for a patient’s wishes to be known and ultimately honored.
Numerous communities across the country have begun similar “community conversations” that are designed to increase a willingness and ability to tackle these tough issues as well as provide specific tools to guide the discussion. TPOPP is one such tool that allows patients, at the appropriate time, to determine the level and extent of medical care they wish to receive.
Because TPOPP is a physician order based solely on the patient’s desires, having such a conversation and accompanying document will further ensure the patient’s wishes are respected and the patient isn’t exposed to unwanted and unnecessary medical procedures.
There’s no getting around it — these are tough conversations to have. Experience has taught us that those individuals who have had the courage to visit with their trusted physician and loved ones about end of life issues often avoid unnecessary drama at this special time which allows them to focus on the most important things in life.