VITAS Healthcare, a subsidiary of Chemed (NYSE: CHEM), is launching a new certificate program to educate health care professionals on how to conduct advance care planning conversations. The company announced the initiative in conjunction with the upcoming National Healthcare Decisions Day on April 16.

Participants in the certificate program will learn skills such as prognostication, hospice basics, strategies for initiating these conversations sensitively and respectfully using open-ended questions.

The training also involves practice scenarios where participants can test what they’ve learned and receive feedback on performance, according to Joseph Shega, M.D., executive vice president and chief medical officer for VITAS.

“We know these conversations upstream of hospice are important, which is why VITAS is doing something about it,” Shega told Hospice News. “To help educate and empower healthcare professionals, such as nurses, nurse practitioners and physicians, to have conversations with patients about their end-of-life care.”

The company plans to officially launch the program in July at the National Black Nurses Association Annual Conference. Nurses, nurse practitioners, physician assistants, and physicians are eligible to participate, Shega said.

Expanding access to this kind of training is sorely needed among clinicians, most of whom receive very little exposure to advance care planning or goals-of-care discussions during their professional education.

The American Geriatrics Society in 2018 reported that 99% of physicians say they believe that these conversations are important, but only 29% indicated that they had received formal training on how to conduct them.

“There is a general consensus that these conversations are incredibly important. The industry has made advance care planning conversations reimbursable, and the industry has evolved how the system supports health care providers having these conversations,” Shega said. “Health care providers are aware that they play an important role in initiating these conversations, and patients want to have them. The issue, then, is a persistent gap in skills and training.”

Advance care planning has been associated with higher likelihood of hospice enrollment and lower incidence of intensive therapies, even during hospital stays, a 2019 JAMA Network study found.

Historically, advance care planning has been underutilized, but an upswing has occurred during the COVID-19 pandemic, a VITAS poll found.

Nearly 30% of people in the United States reported that in 2021 the pandemic increased the likelihood that they would discuss documenting their wishes, according to the VITAS research. Though this is a smaller contingent than the 68% who said that these conversations are important or very important.

VITAS researchers also reported gains in utilization among women and people of color, who continue to experience disparities in access to advance care planning, hospice care and other services.

The data indicated that 36.7% of women have written down their wishes and values compared to 27% last year.

Black Americans reported the largest increase; 39.4% in 2022 said they were likely to discuss or document their wishes compared to 28% in 2021.

The pandemic’s toll is nearing 1 million fatalities nationwide thus far. This has led families to begin considering their wishes for the end of life in greater numbers. But this momentum could slow as COVID-19 recedes. 

Thus far in 2022, the percentage of individuals who said the pandemic spurred their interest in documenting their wishes fell to 22.5%, compared to last year’s 30%, VITAS found.

Most patients expect their health care providers to initiate these conversations, but 71% of respondents to the VITAS poll said that their physicians have never broached the subject.

“These conversations are necessary. Advance care planning is a conversation that might take practice, but patients are ready for it, and they need it,” Shega said. “People are looking to health care professionals to start these conversations. Every end-of-life conversation must be rooted in respect, compassion and empathy.”