Courageous conversation: Talking to your patients about advance directives

This post was written by Christina Hunt, BS, RRT-NPS.

I consider myself an optimist. I try to think about the “best case scenario” in almost every situation that I encounter. In the medical world, we often talk about outcomes. We consider possible outcomes when we are deciding on treatment plans or starting any new course of therapy. As medical professionals, we are prepared to make decisions wherever the road might lead. Whether the outcome is good or poor, we have a plan. But I have a question for you… are your patients prepared?

Discussions centered around advanced directives should not only be directed at the chronically ill or elderly. The Covid-19 pandemic was eye-opening. We saw increased fatalities from the coronavirus, and often those individuals were not prepared with advance directives. Families were forced to make end-of-life decisions (often over the phone). We know as a society, that many of us leave instructions or wishes after our deaths. However, do your patients have instructions for their health care teams, families, and loved ones for the act of dying?

Here are some thoughts on how to have a courageous conversation with your patients about advance directives.

Identify patients that need an advance directive. Who should have an advanced directive? Answer: Everyone! As I mentioned before, the pandemic showed us that everyone should have an idea about what therapies and treatments should be instituted in the event they are unable to make decisions on their own. At the very least, your practice may want to establish identifiers regarding age and health status. You can also add an “interest to learn more” area to registration forms.

Provide education. Do not assume that patients know what we are referring to when we talk about an advance directive, sometimes referred to as advance health care directives. Many patients do not have a clear picture of what information is included in an advance directive or why it is used. There also can be a stigma attached which can be very unsettling to patients. Health care teams should have properly vetted educational materials on hand and be easily accessible to patients. Educational displays in waiting rooms and exam rooms are another opportunity to inform your patients about advanced directives as they wait to be seen. Also, consider including educational materials on advance directives in new patient paperwork.

Communication does not start with a form. We all know that offices and clinics are extremely busy but approaching the conversation about advance directives does not start with a completed form. Use criteria established by your practice to start the conversation with your patient when you have them face to face. Start the conversation with a generalized statement like, “It is a standard practice of mine to talk to all my adult patients (old and young) about….” Using statements like this helps the patient feel as though you are providing important information useful to all patients versus questioning their prognosis. Moreover, this becomes your standardized approach to setting up advanced health care directives. If there is interest by your patients to learn more, have educational materials ready for them to take home along with an advance directive form they can return at their convenience. Make a note on the chart or electronic medical record to follow up on this subject at the next appointment.

You may need to discuss it more than once. For some patients, decisions about advanced directives can be complicated by issues like family dynamics, myths, and their own health history. Sometimes, it is just about timing. Patients may be trying to digest the presence of a new chronic diagnosis or have just lost a loved one of their own. If the idea of an advance directive is immediately dismissed, make a note to talk with them again in six months to see if their thoughts have changed.

Talking to your patients about advance directives does not have to be uncomfortable. In fact, the more often health care providers have these conversations about this subject, the more comfortable they will be. Realize this conversation may take empathy and patience yet it is an important part of each patient’s care plan. How do you approach educating your patients on advance directives? What questions do patients commonly ask when establishing an advance directive?

For information for your patients on advance directives, download a single-use copy of the “Guide to Advance Directives” in the COPD Foundation downloads library. This guide is also available in print for purchase from the COPD Foundation Education online catalog.