Coalition for Compassionate Care of California

Our vision is to transform care during serious illness and towards the end of life in California so that medical care is aligned with an individual's preferences -- people get the care they need and no less, and the care they want and no more. We envision that, in ten years, advance care planning discussions will happen seamlessly and continually over the course of a person's life span, appropriately triggered by life events and changes in medical condition.

The demand for high-quality palliative care will be widespread: conversations about values and goals regarding healthcare will be a normal part of communities. From the time of diagnosis through advanced stages of illness, patients and their families will receive the information they need to make fully informed decisions, have the opportunity to document their treatment wishes, and receive care consistent with these wishes.

The supply of providers and systems capable of supporting patients and families though advanced illness and end-of-life care will be robust. Healthcare professionals will be trained in conversations about goals of care, will feel comfortable talking with patients about treatment preferences, and will skillfully guide patients and families to receive appropriate care. Healthcare organizations will establish systems to make conversations about treatment goals and options a reliable, consistent part of care and will ensure information about patient preferences is easily accessible when needed. Public policy and provider reimbursement will support these conversations and the ability to share documentation of preferences across the care continuum.

We are working to increase demand for patient-centered care during serious illness through public education and engagement and patient empowerment.

We are increasing supply of healthcare providers and organizations prepared to support individuals and families throughout the course of their lives by 1) improving clinicians' approaches to communicating with patients and families by changing attitudes, increasing knowledge, and building skills; and 2) improving organizations' workflows and systems for eliciting, documenting, and honoring patient preferences.

We are increasing the capacity of the California network to improve end-of-life care.

CCCC has a proven track record of leading large-scale, multi-organizational initiatives. A fundamental part of our approach to improving end-of-life care is building and sustaining robust partnerships with the full spectrum of organizations that touch or impact people with serious illnesses and their families. We continue to build on this history of partnership to achieve our goals.

California has always been an innovator in end-of-life care, and CCCC is building the foundation to make real change happen in many ways:

•We provide our expertise, tools and resources to families, patients, policy makers and healthcare providers to help ensure that all Californians receive high-quality palliative and end-of-life care.

•We lead efforts to train healthcare professionals about Physician Orders for Life-Sustaining Treatment (POLST), as well as cultural diversity and end-of-life care in California. We help them develop the skills they need to talk with seriously-ill patients and families facing decisions about goals of care.

•We work with and support local coalitions throughout the state that provide support and education to healthcare providers and those facing treatment and care decisions.

•We bring together people with a passion for increasing access to palliative care to spark growth of community-based palliative care throughout California.

Recent accomplishments include the following:
o Educated more than 40 individuals on how to train others to present on advance care planning or facilitate advance care planning conversations.

o Worked with local initiatives in Santa Cruz and Sonoma Counties to increase awareness of advance care planning among their local Latino population.

o Supported the West Los Angeles coalition in efforts to engage the homeless population in advance care planning.

o Sponsored two POLST-related pieces of legislation: AB 637, which would allow nurse practitioners and physician assistants, under the supervision of a physician and within their scope of practice, to sign POLST forms; and SB 19, which would establish an electronic POLST registry operated by the CA Department of Health & Human Services.

o Trained 73 healthcare professionals how to teach others to have compassionate, quality conversations with patients about goals of care and POLST.

o Produced a white paper that examines the conservatorship process for people with developmental disabilities related to healthcare decision making and includes policy recommendations.

o Hosted monthly webinars to provide education on a variety of palliative care topics. Past webinars have focused on topics as diverse as prognosis, community-based palliative care, telemedicine, billing, Alzheimer's and dementia, and the roles of specialists in the palliative care setting.

o Convened CCCC's 7th annual Palliative Care Summit in Sacramento that was attended by more than 300 healthcare professionals who want to spur growth and expansion palliative care across the continuum of care in California.

o Partnered with the CSU Institute for Palliative Medicine to develop an in-person and online palliative care curriculum for insurance company case managers.

o Actively participated in stakeholder workgroups and provided written recommendations to the DHCS to assist the Department in enacting the provisions of SB 1004, which requires Medi-Cal to establish standards and provide technical assistance for Medi-Cal managed care plans to ensure delivery of palliative care services.

o Hosted two seminars for healthcare professionals to help them explore their cultural biases and gain insight on the effect of culture and ethnicity on end-of-life care.

o Co-authored the California HealthCare Foundation report Gather Round: Understanding How Culture Frames End-of-Life Choices for Patients and Families, based on qualitative interviews with 24 sets of patients and their families who have experienced serious illness.

o Published an online “toolkit" to assist local coalitions in outreach to faith leaders and hosted introductory seminars in their communities about advance care planning and palliative care.