Raising Voices: The Ethics of Dialogue and Communication in Health Care

Transcription

1 Thursday, April 11, :00 8:15 Welcome Nicolae Morar, Ph.D., University of Oregon Michael Schill, President, University of Oregon John Holmes, Ph.D., PeaceHealth 8:15 9:30 Keynote: Weaponizing Principles: Clinical Ethics & the Plight of the Morally Vulnerable Autumn Fiester, Ph.D. 9:30 9:40 Walk Time Obscured Voices in Healthcare 9:40 10:50 A1 Medical Decision Making: Exploring Generational and Cultural Differences Using Graphic Narrative Molly Osborne, M.D., Ph.D. Julia Zottola A2 Scrubs aren t Really Unisex: A Journey across Genders as a Patient, Nurse and Educator Nicholas X. Luisi, M.S.N, R.N., C.C.R.N., U.S. Army CPT (Ret.) A3 The Lost Voice: Elderly Trauma Patients & The Downside of Presumed Consent Susan Tolle, M.D. David Zonies, M.D., M.P.H. A4 Understanding & Addressing Gender Violence in Medical Training: An Ethical Imperative Caroline King, M.P.H. Kelsey Priest, M.P.H. 10:50 11:10 Break (snack provided) Organizational and Structural Pressures which Interfere with Patient Voices 11:10 12:20 B1 We TALK about Equity, but what do we DO about Equity? Organizing for all Oregonians to be able to read their pill bottles in a Language they Understand Kristen Beiers-Jones, R.N., M.N. Lauren Kaplan, P.M.H.N.P-B.C. Brian Park, M.D., M.P.H. 12:20 1:05 Lunch B2 You Only Die Once: How Health Care Providers May Contribute to a Less-Than- Perfect Death by Creating Pressure to Have One! Barb Hansen, M.A., R.N. Extended Workshop: Ethical Issues in Dialogue and Communication in Healthcare 1:05 2:40 Techniques for Effective Dialogue in Challenging Ethics Consultations Autumn Fiester, Ph.D. 2:40 2:45 Walk Time 2:45 3:45 Case A Bonnie: Bad News vs. Autonomy Barbara Glidewell, M.B.S. 3:45 4:00 Coffee break Case B Mr. Williams: Decision- Making Capacity Laura Hosford, M.A. B3 Coping with Moral Distress in Clinical Practice Denise Dudzinski, Ph.D., M.T.S. Case C Mr. Brown: The Unrepresented Patient Keren McCord, L.C.S.W., O.S.W.-C. B4 X-Ray This: Conceptual & Methodological Considerations for Connecting People, Place, & (Bio)Politics in Patient- Provider Settings Ryan Petteway, Dr.P.H., M.P.H. Case D Patient Refusal of treatment Melissa Monner, M.S. 4:00 5:00 Case Follow-up & Ethics Discussion Autumn Fiester, Ph.D. 5:00 Thursday s reflection - Lynn A. Jansen, Ph.D., R.N.

2 Friday, April 12, :00 8:05 Welcome Back - Lynn A. Jansen, Ph.D., R.N. 8:05 9:20 Health Literacy & the Ethics of Clear Communication Clifford Coleman, M.D., M.P.H. 9:20 9:30 Walk Time Socially and Culturally Situated Voices in Healthcare 9:30 10:40 C1 Structural, Social, and Self Stigma: Ethical Dimensions of Health Disparities Experienced by Individuals who use Drugs Robin Baker, M.S., Ph.D. 10:40 11:00 Break (snack provided) C2 Bioethics and Culture: Implications in Immigrant and Refugee Mental Health Insights from Philosophical, Spiritual, and Cultural Analyses 11:00 12:10 D1 Beyond Biology or Disparity: A Harder Way of Thinking About Race Camisha Russell, Ph.D. D2 Moral Injury: A Soulful Journey for Veterans, Providers, and Community Members F. Matthew Schobert, M.Div, L.C.S.W. Gregory J. Widmer, M.Div, CCC 12:10 1:00 Lunch 1:00-1:55 So Tired of Life: What Does Respect Require? Lynn A. Jansen, Ph.D., R.N. 1:55 2:05 Walk Time C3 Global Health Ethics: Appropriate Training for the Next Generation Melissa Graboyes, Ph.D., M.A., M.P.H. D3 Bridging Indigenous Wisdom and Western Ways: Healing Practices for a Modern World Jai Medina, M.A. C4 My Brain has a Pair of Scissors: Learning from the Stories of Patients with Disabilities Elizabeth Wheeler, Ph.D. Mary Wood, Ph.D., M.A. D4 Don t tell the Doctor this but : Ethical Challenges in Medical Interpretation Meeting the Patient Where They Are 2:05 3:30 E1 Street Medicine: Bringing Care to our Neighbors who are Living on the Streets Daniel Bissell, M.D. Drew Grabham, L.C.S.W. Lacey McCarley, R.N. William Toepper, M.D. 3:30 3:45 Coffee break This session is no longer available. E3 Vulnerable & Marginalized Patients: Now you See Them, Now you Don't. How to Truly See & Hear Your Patients So that They will Come to See You. Tera Roberts, D.N.P., F.N.P.-C. E4 Listening for Non-Religious Belief Systems in Healthcare Ethics Consultation Micki Varner, M.Div, B.C.C. 3:45 4:50 Conference Wrap-Up: What was our vision? What did we achieve? What were the surprises? John Holmes, Ph.D., H.E.C.-C. Nicolae Morar, Ph.D. 4:50 5:00 Thank you for joining us at this year s Kinsman Conference!

3 Session Objectives Keynote Address 8:15-9:30 AM Weaponizing Principles: Clinical Ethics & the Plight of the Morally Autumn Fiester, Ph.D. 1. Explain how clinicians and ethicists can inadvertently use principles to silence participants in a dialogue. 2. Define moral archaeology and its use in creating constructive dialogue between providers, patients and Vulnerable families. 3. Understand the ways in which the dominant principlist paradigm magnifies the problems of the morally vulnerable. Breakout Session A Obscured Voices in Healthcare 9:40-10:50 AM A1 A2 A3 A4 Medical Decision Making: Exploring Generational and Cultural Differences Using Graphic Narrative Scrubs aren t Really Unisex: A Journey across Genders as a Patient, Nurse and Educator The Lost Voice: Elderly Trauma Patients & The Implications of Presumed Consent Understanding & Addressing Gender Violence in Medical Training: An Ethical Imperative Molly Osborne, M.D., Ph.D. Nicholas X. Luisi, MSN, RN, CCRN, U.S. Army CPT (Ret.) Susan Tolle, M.D. David Zonies, M.D., M.P.H. Caroline King, M.P.H. Kelsey Priest, M.P.H. 1. Generational and cultural differences in medical decision making. 2. Using Graphic Narrative to demonstrate generational and cultural medical decision making. 3. Broken speech: A graphic narrative of a vulnerable patient. 1. Understand the clinical importance of documenting gender identity. 2. Explore variances in perception of patients and the role of gender. 3. Learn methods to improve education of health care providers from the classroom to the workplace. 1. Explore the changing demographics of trauma care. 2. Define the role of trauma care in providing care for those who wish comfort focused treatment. 3. Learn how those with POLST orders for Comfort Measures Only can have their wishes honored in the trauma system. 1. Understand gender violence related terminology, behaviors, and public health implications. 2. Understand the organizational, policy and regulatory constraints for addressing gender violence in medical training. 3. Understand the barriers to reporting gender violence in the medical training environment. 4. Understand the limitations of current research on gender violence in medicine. Breakout Session B Organizational and Structural Pressures which Interfere with Patient Voices 11:10-12:20 PM B1 We TALK about Equity, but what do Kristen Beiers-Jones, R.N., 1. Identify the strategies to progress from recognizing an inequity (language access) to bringing a bill to the we DO about Equity? Organizing for M.N. legislature. all Oregonians to be able to read Lauren Kaplan, PMHNP-BC 2. Discuss the ethical, safety and cost issues when limited English proficient patients are denied their Civil Rights. 3. Describe the policies, systems, and structures that distribute health/social outcomes inequitably. their pill bottles in a Language they Brian Park, M.D., M.P.H. 4. Explore the silencing of patient voices in equity work. Understand B2 B3 You Only Die Once: How Health Care Providers May Contribute to a Less-Than-Perfect Death by Creating Pressure to Have One! Coping with Moral Distress in Clinical Practice Barb Hansen, M.A., R.N. Denise Dudzinski, Ph.D., M.T.S 1. Discuss variations and myths in the concept of what a perfect death is in our society. 2. Discuss how different facets of the health care system can impact not only how a person s death occurs but also how it is perceived. 3. Discuss strategies health care providers can implement to facilitate mitigation of the impacts of bias on the acceptance of patients choices regarding death. 1. Define moral distress and identify examples from clinical practice. 2. Utilize the moral distress map to differentiate moral from emotional aspects of moral distress. 3. Develop skills and strategies for identifying and reducing moral distress.

4 B4 X-Ray This: Conceptual & Methodological Considerations for Connecting People, Place, & (Bio)Politics in Patient-Provider Settings Ryan J. Petteway, Dr.P.H., M.P.H 1. This session will discuss core limitations/opportunities within public health focused on understanding how place affects health, raising fundamental ethical concerns in regard to pervading conceptual, procedural, and methodological orientations/paradigms. 2. This session will introduce and detail a new tool X-Ray Mapping care-providers can use in collaboration with patients to: 1) identify and map community health conditions that affect patient well-being, e.g. SDH, 2) discuss the importance/impact of local SDH on patient health opportunities/outcomes, and 3) build mutual understanding of local SDH. 3. This session will discuss the X-Ray Mapping process as a way to enhance understanding and uses of "information technology" within patient-provider settings, specifically highlighting smartphones and webbased mapping platforms. Extended Workshop: Ethical Issues in Dialogue and Communication in Healthcare Time Title Speaker(s) Sessions Objectives 1:05- Techniques for Effective Dialogue in Autumn Fiester, Ph.D. To learn approaches that can detract from and enhance effective facilitation of a dialogue between stakeholders 2:40 pm Challenging Ethics Consultations in an ethics conflict. Ethics Case Discussion PLEASE NOTE: ATTENDEES WILL BE PRE-ASSIGNED TO SPECIFIC GROUPS (A, B, C, D). GROUP ASSIGNMENT WILL BE NOTED ON THE NAME BADGE RECEIVED AT REGISTRATION. 2:45-3:50 PM Case A Bonnie: Bad News vs. Autonomy Barbara Glidewell, M.B.S. Attendees will break into small groups to discuss an ethics case in depth. Case B Mr. Williams: Decision-Making Capacity Laura Hosford, M.A. Attendees will break into small groups to discuss an ethics case in depth. Case C Mr. Brown: The Unrepresented Keren McCord, L.C.S.W., Attendees will break into small groups to discuss an ethics case in depth. Patient M.S.W., O.S.W-C Case D Patient Refusal of Treatment Melissa Monner, M.S. Attendees will break into small groups to discuss an ethics case in depth. Extended Workshop: Ethical Issues in Dialogue and Communication in Healthcare Time 4:05-4:55 PM Ethics Cases Follow-up & Discussion Autumn Fiester, Ph.D.

5 FRIDAY, APRIL 12, Kinsman Bioethics Conference Breakout Session Titles and Objectives Plenary Time 8:05 9:20 AM Health Literacy & the Ethics of Clear Communication Clifford Coleman, M.D., M.P.H. 1. Recognize the prevalence of low health literacy among patient populations. 2. Describe the imperative for using a universal precautions approach to health communication. 3. List five best practices to help ensure clear communication with patients and caregivers. Breakout Session C Socially and Culturally Situated Voices in Health Care 9:30 10:40 AM C1 Structural, Social, and Self Stigma: Ethical Dimensions of Health Disparities Experienced by Individuals who use Drugs Robin Baker, M.S., Ph.D. 1. Discuss the landscape of health services and the health disparities experienced by individuals who use drugs 2. Define stigma and distinguish the three types of stigma that impact access and quality of health services for individuals who use drugs 3. Interpret the health disparities experienced by individuals who use drugs and evaluate different approaches to treatment with an ethical lens C2 C3 C4 Bioethics and Culture: Implications in Immigrant and Refugee Mental Health Global Health Ethics: Appropriate Training for the Next Generation My Brain has a Pair of Scissors: Learning from the Stories of Patients with Disabilities Melissa Graboyes, Ph.D., M.A, M.P.H. Elizabeth Wheeler, Ph.D. Mary Wood, Ph.D., M.A. 1. Summarize the current state of displacement in the world and Oregon s role in refugee resettlement. 2. Discuss the history and treatment model of the Intercultural Psychiatric Program in Portland, Oregon. 3. Consider bioethical principles in working with diverse patient populations of multiple religions, belief systems, and cultural norms. 4. Review several clinical examples in which ethical dilemmas arise in mental health care for immigrants and refugees. 1. Discuss some of the ethical challenges when determining how best to train future global health workers, including dilemmas around appropriate internship experiences and the values of clinical shadowing. 2. Explore how an inter-disciplinary approach that fully integrates the humanities and social sciences can better train future global health workers. 3. Present novel practices the UO s global health program has adopted in its goal of ethically training global health workers. 1. To grasp the importance of listening to the ways patients with disabilities describe their own experience. 2. To become aware of and self-reflective about clinician assumptions and pre-conceptions about people with disabilities. 3. To learn about important texts and blogs by writers with disabilities that are good sources of stories about what it's like to be a patient with disabilities. Breakout Session D Insights from Philosophical, Spiritual, and Cultural Analyses 11:00 12:10 PM D1 Beyond Biology or Disparity: A Harder Way of Thinking about Race Camisha Russell, Ph.D. 1. Familiarize participants with three typical ways of thinking about race (as biological, as socially constructed, as a driver of culture). 2. Introduce a fourth way of understanding race, as an organizing social idea so pervasive that it influences the very framework of scientific theories. 3. Offer examples of this framing power of race to urge participants take deeper account of its influence in their own research and professional practices. D2 Moral Injury: A Soulful Journey for Veterans, Providers, and Community Members F. Matthew Schobert, M.Div, L.C.S.W. Gregory J. Widmer, M.Div, CCC 1. Participants will describe the characteristics and impact of Moral Injury with combat Veterans. 2. Participants will recognize the unique role and contribution that Veterans, health care providers, helping

6 D3 D4 Plenary Bridging Indigenous Wisdom and Western Ways: Healing Practices for a Modern World Don t tell the Doctor this but : Ethical Challenges in Medical Interpretation Jai Medina Time 1:00 1:55 PM So Tired of Life: What Does Respect Require? Lynn A. Jansen, Ph.D., R.N. Breakout Session D Meeting the Patient Where They Are 2:05 3:30 PM E1 Street Medicine: Bringing Care to our Neighbors who are Living on the Streets E2 E3 E4 This session is no longer available. Vulnerable & Marginalized Patients: Now you See Them, Now you Don't. How to Truly See and Hear Your Patients So that They will Come to See You Listening for Non-Religious Belief Systems in Healthcare Ethics Consultation Dan Bissell, M.D. Drew Grabham, L.C.S.W. Lacey McCarley, R.N. Bill Toepper, M.D. Tera Roberts, D.N.P., F.N.P.-C Micki Varner, M.Div, B.C.C. professionals, Native American Healers, and community partners bring to addressing combat Veteran s healing from trauma. 3. Participants will understand the tools, techniques, and interventions of the VA Portland Health Care System s Compassionate Warrior Training & Reintegration program. 1. Participants will be able to identify differences and places of convergence between ancient/indigenous ways of healing and modern medicine and psychology. 2. Participants will gain effective strategies to increase cultural competency in clinical practice. 3. Participants will learn about wounded healer syndrome, and be given practical tools to support their own wellness. 1. Review current literature on the benefits of interpreters in health care settings for those with limited English proficiency. 2. Discuss the different roles interpreters often assume in their work and the complications which may result for clients, family, and staff. 3. Describe the general method of interpretation used at our program and the rationale behind it. 1. Discuss characteristics of tired of life patients. 2. Review trends in the treatment of tired of life patients. 3. Review ethical considerations bearing on the healthcare professional s role in caring for patients who are tired of life. 1. Talk about the reasoning behind why we started Portland Street Medicine and talk about what we are trying to accomplish. 2. Talk about some of unique ethical /clinical challenges we see from providing care on the streets and how we address these. 3. Talk about who Portland Street Medicine is for, the people we serve, for the providers themselves and for the community. 1. Identify the under-represented and/or vulnerable populations and the way traditional health care structures limit their voices. 2. Recognize the social determinants of health that limit the voice of the under-represented and/or vulnerable populations. 3. Learn non-traditional communication strategies to improve health care advocacy and access. 1. Define and discuss non-religious belief systems. 2. Reflect on the influence of our own beliefs in healthcare ethics consults. 3. Explore strategies for effectively recognizing and engaging a patient or family member s non-religious beliefs which inform their decision making. Plenary Time 3:45 - Conference Wrap-up John Holmes, Ph.D., H.E.C.-C. 1. What was vision? Did we achieve it? What were the surprises? 4:50 PM Nicolae Morar, Ph.D.