Advance care planning

A version of this post first appeared at https://www.seniorly.com/.

Last week I wrote about understanding individuals’ wishes as a means of providing culturally sensitive palliative care.  That assumes the individual in question knows their wishes and can communicate them or has someone who can communicate for them.

Advance care planning is one way to increase the odds that your wishes will be honored.

Be forewarned – there are forms involved.  They can make it looks as simple as checking some boxes, finding a witness or two, and signing your name.

In reality, of course, there is a lot of thinking and some difficult conversations that need to happen first.  You are, after all, giving someone the legal ability to make medical decisions for you if you aren’t able to.  That could be anything from releasing medical records to removing life-sustaining treatments.

It’s daunting and when you’re in reasonably good health, it’s tempting to put it off.  In fact, most of us do.  Only a small proportion of people have some sort of documentation about their care preferences with the numbers, not surprisingly, increasing dramatically among people who are clearly facing the end of life.

And yet, there is research evidence that patients with some form of advance directive are more likely to have the care they want at the end of life.  Even more compelling, those with specific, clear documentation of their wishes have a better quality of life in the week before they die than those who don’t.

The documents – advance directives, living wills, durable power of attorney, do-not-resuscitate order, Physician Orders for Life-Sustaining Treatment – are all just mechanisms for communicating your wishes.  Advance Care Planning  is the process to get you there.  It’s how you learn about what types of decisions might be needed, figure out what you want in relation to those decisions, and share them with your family and health care providers.  It’s how you figure out and share your values and wishes related to end-of-life-care.

This isn’t easy and it’s not something you do once and never look at again.  Your wishes are likely to change over time and may be different as your circumstances change.  You’ll need to revisit the process and update the documentation. There are lots of resources out there to help you get started. The National Institute on Aging is a good place to start.

Have you done advance care planning?  I’d love to hear about your experiences.