How to talk to patients about advanced directives
Friday, April 17, 2015
April 16 has been designated as National Healthcare Decision Day. This movement came out of the passion and frustration of founder Nathan Kottkamp. As a member of several hospital ethics committees, he was repeatedly challenged with trying to interpret healthcare decisions for people who had no advanced directives. Anyone working in a hospital — especially a critical care area — can certainly relate.
Although most healthcare providers would agree that all patients should have an advanced directive, they often shy away from having the conversation with their patients.
Often, physicians can never seem to find the appropriate time to bring it up, until it is to late and decisions are made under distress. Nurses frequently state they feel uncomfortable talking to patients about medical decisions, although they are the trusted professionals usually best suited for the compassionate conversation.
So how can healthcare providers best help their patients in making one of the biggest and compassionate decisions they can make for themselves and their families?
Know your own feelings
If providers are uncomfortable with their own mortality, they are unlikely to be comfortable discussing it with strangers. Providers need to think through their own thoughts and feelings. When you are more comfortable with your own beliefs, thoughts and wishes, you are likely to be more willing to speak with your patients and not fear questions.
We are not accustom to discussing death in the American culture, unlike other societies, who speak freely of the inevitable and accept its arrival as the part of life.
Know the laws in your state
Although most of the concepts surrounding advanced directives are similar, each state has specific guidelines and statutes that need to be adhered. However, most advanced directives are portable and should be honored, even across state lines.
Typically, what becomes an issue is that determining the next of kin can be tricky when a healthcare proxy has not been named. This is where healthcare providers must know their state statutes.
For example, in some states it is the eldest child or sibling, while in others it is whoever is readily available to make decisions. Educate yourself so you can better serve the patients and families.
Know what makes up advanced directives
Healthcare providers may be familiar with the terms healthcare proxy, power of attorney or living wills, but often do not fully understand what each is or when they are to be honored.
Take the time to educate yourself from reliable sources. We must understand what each document represents if we are to safely and appropriately educate the patients and community.
Know when is the appropriate time to have the conversation
Sadly, critical conversations are made at times when the family is under extreme distress. Family members are approached by the healthcare team to determine if life support should be considered or even discontinued, but often families have not had key conversations and are left guessing what their loved ones would want.
We need to be proactive with our patients and realize that "now" is the right time, for later will be too late. There is a thought that advanced directives are only for chronic, terminal or elderly patients, but really these conversations need to be had with every adult.
Anyone can be in a life-threatening situation, unable to speak for himself or herself — accidents are equal-opportunity situations. So, we must get the conversation going and started.
When a patients have an advance directive, it is the most compassionate thing they can do for their families. There is not greater tragedy than watching a family suffer while trying to decipher what their loved one would have desired at the end of life. As Ira Byrock, M.D., so graciously said, "I have an advance directive, not because I have a serious illness, but because I have a family."
For more information to start your advanced life care planning, you can visit the National Healthcare Decision Day website.
Now, go start the conversation.
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