Making Healthcare Decisions in Advance Eases Stress and Builds Trust

It’s never too early to start having the conversation with patients and families.

April 16th is National Healthcare Decisions Day, and as spring approaches and we‘re thinking about a fresh start, it’s a good reminder to check in with patients or residents and their families about their healthcare wishes. Understanding the goals of those we serve allows us to ensure we are able to provide the care and guidance that they desire. It can also lead to reduced costs for healthcare providers and better satisfaction with health outcomes.  

To have these conversations, it’s important to refamiliarize ourselves with how to codify the key decisions that individuals face regarding their care both before and leading up to the end of life.  

Codifying Major Healthcare Decisions 

Many patients or residents may need help thinking through the complexities of care and trajectories of a disease. It’s not uncommon for a patient or family to have a procedure or implementation that later leads to regret because they did not fully understand the likely end-result. Several key tools and considerations can greatly increase patient and family knowledge and satisfaction about the care provided.  

• An advance directive, or a living will, is a written, legal document which lays out a patient’s healthcare wishes. These documents eliminate confusion about what care is desired in certain circumstances, especially in a scenario where a patient may no longer be able to express their wishes for themselves. Currently only about one in three US adults complete an advance directive for end-of-life care.¹ An advance directive can be completed by anyone, and requires the signature of witnesses to be legally binding. Advance directives vary from state to state, and you can click here to access the state specific legal forms. Instructions are included at the beginning of each form.  
  • Decisions for patients to consider including in an advance directive may include, but are not limited to, deciding whether to implement a DNR (Do Not Resuscitate) order, utilization of a mechanical ventilator, tube feeding, and use of CPR during cardiac arrest. 
• A Medical Power of Attorney (MPOA) is someone who is appointed to make healthcare decisions when the patient is incapacitated. This person can be whoever the patient desires, including a family member or friend, and it should be someone who the patient has discussed their wishes with and trusts fully. The desired individual should be appointed in the advance directive document. 

Where’s the Benefit?  

Making decisions around end-of-life care is difficult at any time, but being forced to make decisions during a time of crisis can lead to undesired outcomes. Making healthcare wishes known in advance have many benefits. 

For the healthcare professional or partner, benefits include:  

• Advance directives tend to lower costly and ineffective procedures, saving healthcare systems money and lowering 30-day rehospitalization and mortality rates
• Medicare Part B covers advance care planning as part of wellness visits, so many healthcare professionals can bill for these conversations²
• Implementation of hospice or palliative care at the end of life can lead to lower costs and better quality care³
  
• Increased trust from patients and residents 
• Less chance of the healthcare provider having to arbitrate between family members who may be torn about which healthcare options their loved one would have wanted
  

For the patient or resident, benefits include:  

• Reduced stress and uncertainty 
• Reduced undesired procedures and/or hospitalizations 
• Familiarity with what to expect, having a plan in place, and knowing who will make the decision if an unanticipated issue comes up 
• Ability to make choices in advance that honor values and religious or cultural beliefs  

Starting the Conversation(s) 

Because these conversations can be emotionally difficult for families, it’s important to note that making an entire set of decisions in one sitting is often not possible. This may be especially true if the patient is part of a culture which does not regularly talk about death. It’s often up to the healthcare provider to help families understand that once decisions about future care have been made, they can focus on spending quality time with their loved ones and making them comfortable in their final days.    

Introducing that conversation and equipping families with the information and resources they need so they can start to understand what questions to ask is a great first step. It can start as simply as setting aside a few minutes of your time together to broach the conversation. Beginning to familiarize patients and families with the concept of making these decisions in advance, and helping them think through possible outcomes, can result in an end of life experience that respects their wishes.  

References:

1. Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care

2. Advance Care Planning

3. Medicare Cost at End of Life