Thursday, March 28, 2013

How Can Care Management Respond to Patients' Spiritual Concerns?

The Disease Management Care Blog remembers her well.

She knew it was not going to be good news.  That gnawing pain in the pit of the stomach was getting worse and, when the whites of her eyes turned yellow (for example), she knew she had to see the doctor.  The CAT scan confirmed what the DMCB already knew: it was cancer and it was going to kill her in a matter of months.

In the months of DMCB follow-up, the patient talked about her pain, other docs, family, regrets, treatments, comforts, side effects, new limitations, waning appetite, getting skinny, numerous fears, dying and, yes, religion.  Aside from taking a few seconds to drag a stethoscope across her chest or poke at her scarred abdomen, the DMCB mostly listened.

It sat still and listened.

In retrospect, the DMCB was using a long-used strategy of  patient centered empathy.  As a nonegoic counselor, it was enabling the patient to think aloud with a non-judgmental listener and "process" a new reality.  While economists can only speculate on the "impact on claims expense" or the "return on investment," this is a low-cost and high value health care intervention.  It's also a way to accommodate, use and even share in patients' religious and spiritual needs.

Unfortunately, this kind of counseling is also time consuming.  While surveys show that mainstream providers believe in active listening and being engaged in patients' spirituality, perceptions over "professional role conflicts" make actually doing it in a busy clinic another matter.

The DMCB suspects the same ambivalence is present in the care management provider industry.  The DMCB has seen vendor nurses in action, and while their counseling protocols include "readiness for enhanced spiritual well-being," the ability of a telephonic nurse-counselor to meaningfully provide high impact and spiritual listening probably varies from individual to individual.  Long telephone queues make actually doing it another matter.

And the same is true in patient-centered medical homes, where non-physician professional team members are assigned the task of patient counseling in their day-to-day care and case management.

Which is why the DMCB likes community-based organizations like Someone To Tell It To.* When patients are facing a life-altering disease or complication, they often seek guidance that not only falls outside the narrow evidence-based protocols that drive care management, but the interests, ability or beliefs of an individual counselor to offer it.  In a classic "build or buy" decision, companies can develop this resource on their own (perhaps by designating an in-house provider with special skills or interest in this sort of counseling) or "outsource" and referring the patient. 

While it may seem awkward to "outsource" this kind of counseling, the DMCB has examined the rise of health care outsourcing here and here.  If Someone To Tell It To can help patients being followed by care management providers, medical homes or ACOs, why not refer them? 

Why should this important facet of patient care be any different?

*Disclaimer: the non-salaried DMCB spouse serves on STTIT's Board of Directors.


GlassHospital said...

CAT scan = dead link

Jaan Sidorov said...

The link works for me.