Doctoral student Sharon Bigger recently won East Tennessee State University’s Three Minute Thesis Competition with her presentation on “Advance Care Planning Protocols and Hospitalization, Re-hospitalization, and Emergency Department Use in Home Health.”
On Tuesday, the Press asked the Asheville resident to tell us more about her health care interests, starting with some fast facts about herself.
Hometown: Crofton, Maryland
Pets: Has two rescue dogs.
Hobbies: Singing, playing guitar, and contra dancing.
Favorite food. “Broccoli, really!”
What was your presentation about?
The presentation was about advance care planning in-home health among patients with chronic cardiovascular and chronic pulmonary diseases like heart failure and COPD. Advance care planning is a conversation that someone has with their family and health care providers in advance of a medical crisis so that everyone can know about their values, goals, and wishes for future health care treatments. I was looking at the association between home health agencies’ advance care planning protocols and their rates of acute care services use such as emergency department visits and hospitalizations among their patients.
What got you interested in this topic?
I have been a hospice nurse for 15 years. I do a lot of admissions to home hospice, and I have heard a lot of people say, “I wish I had known about this earlier. I wish someone had told me about my choices. I wish I hadn’t gone to the hospital so many times when I could have had my symptoms managed at home.” There is a difference between home health and home hospice. Home health is for people who need health professionals to visit the home to provide care, with the goal of rehabilitation or cure; and that happens sometimes even when rehabilitation or a cure is not realistic. When home health patients have a crisis, they use the emergency room or the hospital. These are considered to be poor outcomes in home health. In contrast, home hospice also provides visiting health professionals but is more comprehensive, providing 24-hour access to crisis care at home. Home hospice is for people who are clear about not wanting to go back to the hospital for a cure but instead to have their symptoms managed at home for their comfort.
Most people believe hospice is a service provided only in the last few days or weeks of life to people who have cancer, when in fact, many people with various diagnoses benefit from the hospice service for many months or years. In fact, studies show that patients who choose hospice or palliative care wind up living a little bit longer because they are comfortable at home and having their symptoms well-managed. The goal of hospice is not to prolong life, nor to hasten death, but to manage symptoms with the goal of comfort. Some patients choose to switch from home health to home hospice when they are clear about not wanting to go back to the hospital anymore. Advance care planning conversations help people get clear about these kinds of decisions and how they personally define quality of life, starting with this question, “What would a good day look like for you?” Everyone’s answer will be different. From there, people can start discussing if they could still have a good day while receiving certain kinds of medical treatments.
What was your reaction to winning the competition?
I was very surprised to have won first place. I knew I was competing with other very talented participants but had no idea against how many people, their topics, or their presentation styles. I was delighted to finally meet John and Thomas when we met to have our socially distanced photos taken. It was an honor to be among the winners of the ETSU competition, and I look forward to the regional competition in February.
How does this relate to the current public health crisis?
Advance care planning is for all adults, not just those with serious illness because anything could happen to anyone at any time. This includes COVID-19. We never know when an accident or sudden illness could render us unable to speak for ourselves, so it is important for all adults to have these kinds of conversations with their families in advance and to ask someone to serve as a spokesperson in case we are not able to speak for ourselves.
For example, my mother had a stroke in August 2019, and the fact that my family and I had discussed these issues ahead of time helped us to make decisions for her when she could not speak for herself. We knew what a good day would look like for her, and that helped guide the decision for her care. My husband and I have the practice of saying “I love you” each and every time we leave the house because we never know if it will be the last time seeing each other. It sounds morbid, but it’s true for everyone — we never know. I do know what kind of care he would want if he couldn’t speak for himself, and he knows what I would want.
What are your plans moving forward?
I plan to graduate in May 2021 with a Ph.D. in Nursing. I plan to teach at the graduate level in topics such as nursing theory, philosophy of science and ethics. I plan to conduct research in the area of chronic disease and palliative care.
Answers have been edited for style and length.