Helping Patients Live—& Die—on Their Terms


 

Many of us were drawn to medicine by a deeply compelling purpose: to save and improve lives. However, as physicians, our duty extends beyond disease prevention, diagnosis, and treatment—we are also charged with helping our patients live their best possible last days.

End-of-life planning is a conversation that might take practice, but your patients are ready for it, and they need it.

Starting The Conversation: Why Wait?

When we repeatedly put off this important discussion, we are doing our patients a disservice. People who document their healthcare preferences in an advance directive are more likely to get the care they prefer at the end of life. It is an opportunity to help the patient feel in control, as well as unburden families and help them feel at ease knowing these decisions have already been made.

However, without any resources for support, breaking the ice can be challenging. In a survey of physicians caring for older adults, 99% agreed that advance care planning conversations with patients is important, but obstacles often get in the way, including:

  • Concerns the conversation might be uncomfortable;
  • Not wanting the patient to lose hope; and
  • Uncertainty about what is culturally appropriate.

A few simple guiding principles can help you start the conversation. There are many available continuing education and training resources for healthcare professionals to maximize patient conversations.

 

Ways to Ensure Effective Advance Care Planning

First and foremost, every end-of-life conversation must be rooted in respect, compassion, and empathy. That means taking the time to understand the whole patient and consider how their age, race, ethnicity, religion, and relationships shape their views and values.

To foster a meaningful, patient-first dialogue in which the person feels safe and supported, keep these strategies in mind.

  • Give the moment the space it deserves. Consider how the physical environment or time constraints can impact a patient’s comfort level during a difficult conversation. Choose a private, peaceful, and comfortable setting and try not to put the discussion last on your agenda when you are likely to feel rushed.
  • Consider their cultural context. Simply put: Ask questions and avoid assumptions. Simply asking how the patient is feeling is an impactful way to start the conversation and establish trust. Before diving in, ask the patient what they would like to know. Ask about their spiritual beliefs, traditions and rites surrounding death, and keep in mind that terms like pain, dignity, and quality of life have different meanings from one person to the next. An open-ended question such as “What does comfort mean to you?” can reveal a lot about your patient’s values.
  • Reflect and recap. Notice the patient’s body language and tone of voice. If the person appears uncomfortable or upset, acknowledge those emotions and respond with empathy. Show the patient you understand them by reflecting what you heard them say. At the end of the conversation, recap the important takeaways from the conversation and decide on next steps together.

Advance care planning is a valuable opportunity to build trust and develop a patient care roadmap that aligns with their unique needs and preferences.