Advance Care Planning and Palliative Care with Dr. Stephen Bekanich

Dr. Stephen Bekanich grew up in a chaotic environment and spent his childhood years being raised by his loving grandparents. This propelled him into palliative medicine because he wanted a more nurturing career life. After his grandmother was diagnosed with metastatic breast cancer and his grandfather was diagnosed with dementia, he became even more interested in palliative medicine. He wanted to be able to effectively take the people he loved through their journey of serious illness, but he was not equipped to do that as a regular physician. 

At the time, palliative medicine was not a recognized field, but it has grown immensely in recent years. Palliative medicine helps patients and families through serious illness, while they receive life-prolonging or curative therapy. Palliative medicine is not hospice, and it does three things:

1. Pain and symptom management - This works to keep the patient comfortable and energized outside of the traditional medical therapy they are receiving.
2. Caregiver support - This is incredibly important and is defined as uncompensated care for a loved one. Caregivers often develop “Caregiver Syndrome” which puts them at risk for premature death simply by being a caregiver to someone else.
3. Advance Care Planning - You can think of this like planning for anything else. If you plan for your health, you get better outcomes.

Advance Care Planning is a series of discussions that occurs with the patient as well as any of their family members or support system.

This form of healthcare planning first consists of disease education because the majority of patients do not understand what exactly is going to happen to them due to their disease state. For example, many people with terminal cancer believe that they will simply receive treatment and be cured. This is often not the case, so educating the patient on their disease and the eventual effects becomes extremely important. 

Influencers of care are also discussed, and this may include the patient’s particular culture, spirituality, family dynamics, personal finance and other things that aren’t talked about in traditional healthcare.  This is an integral part of advance care planning.

Advance care planning walks the patient and their support system down the path of their disease and what it may potentially look like in the future. Someone with cancer is going to have a very different journey than someone with dementia. What are you likely to encounter as your disease changes and progresses? This can be a very eye opening piece of the process.

After these conversations, it’s good to let that process a bit (however that works best for the patient - praying, thinking, asking questions). The output of this is determining the patients goals for care. Many people may like to be independent and remain at home. Other people are happy living in a facility to assist with their care. Ultimately, it’s important to have these conversations in advance of the decisions needing to be made. Dr. Bekanich also recommends everyone have in place a living will and a medical power of attorney. These documents need to be widely accessible to everyone involved in care.

One of the most important reasons for Advance Care Planning is that it gives peace of mind and helps resolve conflict. When you understand what your disease entails and can plan for the future, you avoid scrambling and stressing about it later on. Within families, there can be a variety of opinions and feelings, and this is a great way to get all of those out on the table, plan for them, and know the route you’re going to take. You can think of this as conflict resolution within families.

Iris Plans is not in the corporate practice of medicine and does not deliver the care to patients, they simply facilitate the discussions. They believe that families should have access to this type of care, and it should not cost them anything. Healthcare is the number one cause of personal bankruptcy in the United States, and a great deal of the care delivered during serious illness is unwanted, unnecessary, and not even beneficial. 

While insurance companies may cover much of the traditional treatment, many families are still paying out of pocket. Iris Plans works with accountable care organizations, physician groups, healthcare systems, and insurance plans to ensure that patients do not pay for this care.

The first step is to talk with your insurance company and make sure this is covered for you. It should be, and you should fight for it to be covered. While the insurance company does need to be involved, the important people are the patient and their caregivers and support system. Family, friends, and other support are incredible to have around because the more support, the better the outcome.

Dr. Stephen Bekanich, an Iris co-founder, is a palliative medicine physician, a recognized leader in his field and someone who knows firsthand the importance of high-quality care planning. He founded and directed palliative care programs at the University of Miami Medical Center, the University of Utah Medical Center and Ascension Health. Stephen previously served as CEO of Ascension Health’s Accountable Care Organization in Central Texas, leading 2,500 physicians to successful outcomes including shared savings across their government and private-sector relationships. Stephen has won awards for medical leadership, health care innovation, teaching, and patient and family satisfaction. His work has been shaped by his personal experience.