Talking About Advanced Care Directives

By CareerSmart Learning Contributor, July 28, 2017, as published by Healthcare Hot Spot


Advanced Care Directives are difficult to discuss because many people, healthcare providers and patients alike, are uncomfortable discussing death. While a conversion about Advanced Care Directives will touch upon the subject of death, it really is a conversation focused on ensuring that a patient’s quality of life is respected throughout the entirety of their life. To help start the conversation, here are a couple of things to keep in mind when talking about Advanced Care Directives with patients:

  1. Make it normal. Discussing Advanced Care Directives with every patient normalizes the conversation by making it a matter of routine, not because of a patient’s age or current or potential health issues. A healthcare provider can explain to a patient that they discuss Advanced Care Directives with all their patients, turning what otherwise may be a worrisome conversation simply into a casual one. The provider should be comfortable and knowledgeable about this topic. Having either a sample Advanced Care Directive or a brochure with more information to give the patient is helpful. Setting a relaxed tone and connecting the discussion on Advanced Care Directives as part of the routine plan of care helps normalize the topic and conversation.
  2. This will take time.  Do not expect an Advanced Care Directive to be mentioned, completed, and signed all within one conversation. Discussing Advanced Care Directives is a process involving several steps over weeks or possibly months. The first step is to broach the subject and review what an Advanced Care Directive is. An example of how to initiate this type of conversation may be, “Have you thought about who you would want to make health care decisions for you in an event that you cannot speak for yourself?” Once the topic of Advanced Care Directives has been introduced, it is important to follow up to answer any questions and ensure that the patient understands the importance of having one. Be mindful that many cultures frown upon this type of conversation, and if a patient expresses that they do not want to complete an Advanced Care Directive, a re-visit of this topic should be considered at a later time. Even for patients who want to complete an Advanced Care Directive, it will take several conversations and some persistence to get it completed. Advance care planning requires the patient to consider many treatments and end of life options. It should not be a rushed decision as patients need to fully understand all available options and how their choices will affect their care. Furthermore, because this type of planning is in advance, subsequent discussions about an Advanced Care Directive are important, especially when the patient’s actual health status changes. Even though it might only be one or two sentences on the subject, the healthcare provider is reaffirming the importance of having an Advanced Care Directive with each reminder. 

Healthcare providers are in the best position to educate patients on the importance of advance care planning. It is part of the continuation of care and protects the patient’s healthcare wishes. Centers for Medicare and Medicaid Services recognize the importance of this function and in 2016 added allowable physician’s fee schedules for face-to-face discussion on advance care planning and assistance with completion of related forms. 


National Institute on Aging.  Advance Care Planning: Tips from the National Institute on Aging.  Retrieved from https://www.nia.nih.gov/sites/default/files/advance-care-planning-tipsheet-pdf.pdf

National Institute on Aging.  End of Life: Helping with Comfort and Care.  Retrieved from https://www.nia.nih.gov/sites/default/files/end-of-life-helping-with-comfort-and-care.pdf

July 28, 2017

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