{"id":17965,"date":"2023-09-15T10:01:03","date_gmt":"2023-09-15T14:01:03","guid":{"rendered":"https:\/\/geiselmed.dartmouth.edu\/news\/?p=17965"},"modified":"2023-09-15T10:01:03","modified_gmt":"2023-09-15T14:01:03","slug":"geisel-school-of-medicine-student-creates-a-new-conversation-guide-for-dementia-care","status":"publish","type":"post","link":"https:\/\/geiselmed.dartmouth.edu\/news\/2023\/geisel-school-of-medicine-student-creates-a-new-conversation-guide-for-dementia-care\/","title":{"rendered":"Geisel School of Medicine Student Creates a New Conversation Guide for Dementia Care"},"content":{"rendered":"

As a Swigart Ethics Fellow during her second year at Geisel School of Medicine, Charlotte Berry \u201925, worked on a research project with Robert Santulli, MD, an honorary associate professor of psychiatry at Geisel and a senior lecturer in Dartmouth\u2019s Department of Psychological and Brain Sciences, Amelia Cullinan, MD, an associate professor of medicine and a member of the Dartmouth Health palliative care team, along with dementia patients and their families to create a tool to facilitate advance care planning and improve communication between providers and those affected by dementia.<\/p>\n

\"Charlotte<\/a>
Charlotte Berry \u201925<\/figcaption><\/figure>\n

Drawing on her family\u2019s experiences caring for her mother who was diagnosed with dementia, Berry thought that in addition to an advance directive, patients and their families would benefit from having goal-oriented conversations about care with healthcare providers\u2014ideally early in the disease process.<\/p>\n

Berry\u2019s endeavor to find such a tool led her to the Serious Illness Conversation Guide (SICG), an evidence-based tool designed for clinicians to approach serious illness conversations. While the SICG offers promise for those conversations in dementia, it had not been adapted to address the unique needs of dementia patients.<\/p>\n

\u201cMy aim was to develop a novel version of the SICG to be utilized in the healthcare of individuals with dementia in conjunction with their caregivers,\u201d Berry explains. \u201cWe sought to create this tool with the insight of topical experts and using patient- and caregiver-tested language to aid in incorporating the goals and values of the patient in future healthcare decisions as their cognitive abilities decline.<\/p>\n

\u201cIn retrospect, I think this was a pathway for me to address some of the challenges my family faced as my mother\u2019s dementia progressed,\u201d she says.<\/p>\n

Berry\u2019s adaptation of that guide resulted in the Serious Illness Conversation Guide for Dementia (SICG-D), and led to a published paper, as lead author, in the American Journal of Hospice and Palliative Care<\/em><\/a>.<\/p>\n

In its original form, the SICG offers both strengths and limitations for addressing serious illness conversations in dementia. It is a well-validated tool with widespread use and is easily disseminated for use by healthcare providers who may care for dementia patients. In contrast to other healthcare planning tools such as advance health directives, the SICG is open-ended, focusing on values rather than specific procedures\u2014providing a more flexible and adaptable framework for approaching difficult conversations in dementia.<\/p>\n

Berry and fellow researchers conducted a multi-stage, iterative study design in adapting the SICG for dementia that included feedback from experts in relevant fields, patients, and their families.<\/p>\n

The SICG-D maintains the same general format that underlies the success of the original SICG, with key adaptations that allow for better incorporation of the patient-caregiver partnership, and provides clinicians with dementia-specific language applicable to dementia care and progression.<\/p>\n

Special consideration for the caregiver role incorporates questions and phrases to address their experience and potential associated stress. For example, in the adapted version of the SICG, clinicians are provided with example language for expressing understanding, a phrase emphasizing caregiver burden was added: \u201ccaring for someone with dementia can be very, very difficult.\u201d<\/p>\n

\u201cAs someone who went through this with my family, you can feel a little lost, but I think conversations in the guide about hopes, fears, and worries\u2014in the context of clinical care is important even if it doesn\u2019t necessarily change the outcome,\u201d Berry says. \u201cIt\u2019s especially important toward the end of the disease when loved ones are in the position of making big decisions.\u201d<\/p>\n

\"Santulli\"<\/a>
Robert Santulli, MD<\/figcaption><\/figure>\n

\u201cCharlotte\u2019s paper on the SICG for dementia is an important contribution to the field.\u00a0It is crucial for there to be thoughtful advance care planning for persons with dementia, but there are very few tools available to help clinicians with this task,\u201d says Santulli, who advised her throughout the process. \u201cThis is, in my opinion, the best tool.\u00a0I hope it will be widely adopted.\u201d<\/p>\n

Berry and Santulli met during her undergrad years at Dartmouth after her mother\u2019s diagnosis. \u201cA friend of mine had a good experience taking a course Dr. Santulli taught on dementia and aging. So, I reached out to him because I wanted to talk with someone who understood this disease,\u201d Berry recalls. \u201cWe met, chatted, and he encouraged me to get involved in a project creating an advance healthcare directive for dementia\u2014the Dartmouth Dementia Directive. On a personal level, he has been incredibly supportive of me as I experienced my mother\u2019s diagnosis and death. Professionally, he has encouraged me to contribute to the field of dementia research and our relationship has been academically productive\u2014he\u2019s an awesome mentor and beloved by his patients.\u201d<\/p>\n

\u201cOne of the wonderful qualities of both Dartmouth and Geisel,\u201d Santulli says, \u201cis the opportunity and encouragement for close collaboration between students and faculty on research and other projects.\u00a0No doubt, this collaborative ethic contributed to Charlotte's success in creating such a valuable clinical instrument.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Charlotte Berry \u201925 is lead author of a paper describing a new tool designed to help clinicians facilitate conversations about dementia care.<\/p>\n","protected":false},"author":12,"featured_media":17966,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[14,1],"tags":[1170,771,94],"class_list":["post-17965","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-improving-lives","category-news","tag-charlotte-berry","tag-dementia","tag-robert-santulli","author-12"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-content\/uploads\/sites\/2\/2023\/09\/CharlotteBerry_featured.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4r3h1-4FL","_links":{"self":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/17965","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/comments?post=17965"}],"version-history":[{"count":2,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/17965\/revisions"}],"predecessor-version":[{"id":17970,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/17965\/revisions\/17970"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media\/17966"}],"wp:attachment":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media?parent=17965"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/categories?post=17965"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/tags?post=17965"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}