Becker's Clinical Quality & Infection Control

58 PATIENT EXPERIENCE 3 tips for talking to terminal patients about end-of-life care By Mackenzie Bean O ncologists should have open conversations with terminal cancer patients about their prognosis and end-of-life care to help reduce symptoms of anxiety and depression, according to an edi- torial published in JAMA Oncology. e editorial focuses on a pair of stud- ies, published in JAMA Internal Medi- cine and JAMA Oncology, that followed 278 patients and 91 clinicians involved in the Serious Illness Care Program at Bos- ton-based Dana-Farber Cancer Institute and two affiliated clinics. Researchers found patients involved in the communica- tion quality-improvement intervention had half as many moderate to severe symptoms of anxiety and depression compared to a control group aer 14 weeks, according to AMA Wire. Based on these findings, the editorial's au- thors — Belinda E. Kiely, PhD, and Dr. Mar- tin R. Stockler, researchers at the University of Sydney in Australia — discussed three ways oncologists can improve conversations around end-of-life care: 1. Talk to patients sooner. "Oncolo- gists should initiate conversations about serious illness with patients who have a significant risk of dying in the foreseeable future" because "patients want, require and deserve to know what is coming," the authors wrote. 2. Broaden the conversation. Along with basic care preferences, oncologists should also talk to patients about their values and priorities in life. 3. Make conversation notes accessible to the entire care team. Information about these conversations "should be document- ed, accessible and flagged in the EMR to increase the accessibility to others involved in the patient's care," the authors wrote. n How noncompete clauses can sever patient-provider relationships By Mackenzie Bean N oncompete clauses, which are becoming more common in healthcare, can often drive a wedge between providers and their patients, reported The New York Times. Four things to know: 1. Noncompete clauses seek to prevent departing physicians from taking patients with them to a new or competing practice. A 2018 survey of 1,967 primary care physicians across five states found about 45 percent of respondents had noncompete clauses in their contracts. 2. For patients, physicians who leave their practices under a noncompete clause "seem to simply disappear," according to NYT. The physicians' former practices often refuse to tell patients where their physicians went. Sometimes, patients who track down their physician's new practice may not be admitted because of terms outlined in the noncompete clause. 3. Many physicians claim such clauses disrupt continuity of care, which can be crucial for patients with consistent medical issues. "To the extent that these agreements disrupt continuity of care and disrupt patient choice, this is of great concern to the [American Medical Association]," Patrice Harris, MD, president-elect of the AMA, told NYT. 4. NYT cited a Trump Administration report that recommends states assess how noncompete clauses affect patients' access to care. Some states, like Massachusetts and Colorado, permit noncomplete clauses in employment contracts, but don't typically enforce them against physi- cians. In Texas, noncompete agreements must allow physicians access to a list of their former patients and their medical records. n Why this Boston physician gives his cellphone number to patients By Mackenzie Bean C lement Bottino, MD, a pediatrician at Boston Children's Hospital, has given his cellphone number to patients since he started his practice in 2009. In an op-ed for WBUR, Dr. Bottino said he shares his number with more than 750 patients at his practice, along with hundreds of others during urgent care visits. In 2018, Dr. Bottino received 2,097 texts from patients with messages ranging from photos of rashes to videos of babies tak- ing their first steps. "Most of my paid clinical time is spent rushing through 15-minute visits and slogging through electronic paperwork. With texting, the rush disappears," he wrote. "Patients can text me when they want. ... I can answer questions, put worried parents' minds at ease and prevent unnecessary [emergency room] visits." While Dr. Bottino's family and colleagues sometimes question his work- life balance, he said the texting communication "feels invigorating, the opposite of burnout." n

• Cover