Advance Care Planning: THE TALK

How to approach discussing this topic with patients.

ACP   |   TERMS   |   FORMS

Dr. Ella Farida Meade, DO is a Family Medicine trained physician who specializes in Hospice and Palliative medicine in two unique settings: as an in-patient Hospice and Palliative consultant, and as an outpatient Palliative Care specialist in an Oncology clinic. Advance care planning is a routine part of her day, and a conversation she engages in with ease. We’ll walk you step-by-step through her process of discussing advance directives and POST forms with patients.

  1. This may seem obvious, but assess what your goals are in your discussion. Are you seeking to determine a power of attorney in the ICU or fill out an advance directive with an elderly patient in your clinic? In either case, print off the form you’re wanting to discuss or provide to the patient and read it thoroughly so you can adequately educate your patient as to the utility of the document. All forms for your state (advance directives and POST) can be found on our FORMS page.
  2. In bringing up advance care planning with patients, Dr. Meade is straight-forward in her approach for advance directives,

    I always bring up the subject in the new patient visit. I think this helps offset some of the anxiety surrounding the topic because it may be viewed as “new patient paperwork”, so to speak. It also really helps to mention that EVERYONE should do an advance directive whether young or old, sick or healthy. I usually use the example of a fairly young and healthy person being in a devastating accident of some kind, and treatment can get very confusing and prolonged with a lot of family anguish because nobody knew their wishes surrounding such an event. Most people have either personal experience with a situation like that or know of someone else who has, and they are very receptive to talk about it at that point. I give them a blank copy, ask them to look it over and  fill it out at home, and offer to help them fill it out right there if they want to or bring it back with help filling it out if need be.

    When discussing POST forms, which she does in the in-patient setting, Dr. Meade is fairly blunt in her approach, “Here, let’s go over this and you tell me the kinds of things you want/don’t want. Everyone should have one.”

  3. While talking through advance care planning with patients, Dr. Meade includes a sentiment by telling the patient that by filling out advance directives or a POST form, they are giving a wonderful gift to their family by leaving instructions on what they want rather than have the family try to figure it out, feel guilty, fight amongst themselves, etc. In addition, she strongly encourages patients to select a surrogate who will follow their advance directive rather than doing whatever they want. Having an advance directive is one thing, but as you’ve likely learned, if the selected power of attorney doesn’t know or understand the patient’s wishes, they often push for extraneous measures when the patient can no longer speak for themselves – despite having an advance directive stating otherwise.
  4. When asked for final advice for medical students and residents before having this conversation, Dr. Meade had the following to say:

    I think it would be helpful for the med student or resident to review a copy of the advance directive, which will help tailor their discussion a bit. I would also advise them not to be timid.  It’s not the most pleasant subject but most patients I’ve seen are grateful when I give them a copy. No matter how unpleasant, patients know that death is coming for us all.  I believe the approach that everyone should have an advance directive works very well, and it would be certainly appropriate to do in any Primary Care physician’s office, not just Oncology, Palliative Care, etc.

May your words be kind, gestures gentle, and compassion at the peak of your emotional capacity as a human when talking with families in these moments.