His meds make it difficult to function and do simple things like sitting around a table with friends, having a beer. Within minutes the man is confiding information he may not have told anyone else. I'm so sorry to hear that," she responds. The meds make me dizzy, and when I'm that dizzy I can't drive, I'm trapped in the house. "I've been fighting it for over a year now. "I have a malignant brain tumor," the man tells Noto. To underscore this reality, here's a partial transcript of another phone conversation (released by Vital Decisions with the patient's permission) between a patient and Ariana Noto, another of the firm's counselors: "So when you're faced with a set of choices - none of which represent a really good choice - you become ambivalent." Meanwhile, navigating the medical system and figuring out your priorities can become increasingly difficult as your disease progresses, he says. In Oregon, End Of Life Orders Help People Avoid The ICU The hope of this program, she says, is to build a relationship with the patient over the phone, so he'll be comfortable discussing his situation and his goals with her and, ultimately, feel empowered to communicate those goals with others - his family and his doctors. Schleicher asks the man if it's OK to follow up, in a month or so. I also hear concern from you that 'I don't think that's necessarily going to happen.' Has someone told you that, or is that your own feeling?" Schleicher repeats that back, then continues: "Breathing - OK. "When you say that getting better is the most important thing on your mind, what does that look like for you?" Schleicher asks a Rhode Island man in a typical phone call.īeing able to breathe without an oxygen machine, he tells her. Vital Decisions handles about 12,000 such cases a year. Federal privacy rules permit this sharing of patient information with subcontractors for certain business purposes. The phone sessions, funded by insurers, may span months, with each individual session with the patient or family members lasting an hour or so. Vital Decisions, based in New Jersey, first reaches out via a letter, though patients rarely respond after that, the company's counselors essentially cold-call patients to offer counseling on behalf of the beneficiary's insurance plan. The effort is part of a recent wave of initiatives aimed at fostering these tough conversations. Vital Decisions, where counselors help terminal patients face end-of-life decisions, is a hushed place, filled with the murmur of soothing voices. The firm represents roughly a dozen insurance companies nationally that want to, when appropriate, start discussions with beneficiaries about end-of-life care. Schleicher is one of 50 or so counselors working for a company founded in 2008 called Vital Decisions. "The main goal with us talking is to make sure that you know what's important to you and that your care aligns with what's important to you," Schleicher says, "so that things go the way you want them to." Except she has your phone number, she knows the name of your insurance carrier (the insurance company provided your phone number), and she knows that you're pretty sick. At the start of the call, she knows almost as little about you as you know about her. Kate Schleicher, 27, is a licensed clinical social worker. She wants to talk with you about your serious illness and, eventually, if you're ready to think about it, what you'd like to have happen at the end of your life. This is not a typical telemarketing call. I'm a health care counselor," the gentle voice of the caller says from her cubicle in Cherry Hill, N.J. Kate Schleicher, phone counselor, Vital Decisions is to make sure that you know what's important to you, and that your care aligns with what's important to you.
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