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Empowering Patients to Plan for Care at the End of Life, in the COVID-19 Era and Beyond

Gundersen staff continue reaching out beyond the clinic to help patients prepare during COVID-19

End-of-life planning is a standard part of care at Gundersen Health System in La Crosse, Wisconsin, a city where 96% of residents who die have a plan documented, and it’s become even more essential during the COVID-19 pandemic.

Before the pandemic, Gundersen’s patients were already asked at every visit whether they want to discuss end-of-life care with a doctor or trained facilitator. When the pandemic started, a team of physicians, nurses, and facilitators also began reaching out to their most vulnerable patients to suggest that they document or update their end-of-life wishes.

Clinicians started by talking to patients living in long-term care facilities. Then, they used reports in Epic to prioritize calls to older adults in the community with a high risk of complications from COVID-19.

Patients don’t have to wait for their healthcare provider to start the conversation, though. They can use resources in MyChart to start advance care planning anytime. Questionnaires can help guide conversations with family or friends, and patients can upload important documents or designate health care agents so clinicians can access this critical information if it’s needed.

“It’s normal to be thinking about end-of-life wishes right now,” said Elizabeth Cogbill, MD, Gundersen’s COVID-19 ethicist and lead physician for post-acute care. “In the pre-COVID era, death was something we tried not to think about. Now, the pandemic has made everyone more willing to talk about their choices of care at the end of life.”

Epic community members can learn more about Gundersen’s approach and recommendations from Epic in the End-of-Life Care Planning toolkit on the UserWeb. Patients can visit to sign up for an account through their healthcare provider and add details about their end-of-life wishes.