Every year between March and April, over 1.5 million people visit DC to view the famous cherry blossom trees coming back to life after several wintery months. This event ushers in the unofficial start of spring, bringing a feeling of rejuvenation to the nation’s capital. This beauty of spring will soon change to summer heat, followed by fall and winter—a transition we know is inevitable.
As nature cycles through seasons, so too do we move through stages of life. Births, graduations, weddings, career shifts, home ownership, parenthood…we traverse through the ups and downs.
And as winter comes to nature, it also comes to our lives. We all encounter the loss that is death. Whether you experience it through the passing of a close family member or friend, or read about it in a headline in your local newspaper, we see death often. It is as certain as the changing of seasons, yet we do not take time to plan for it.
This Monday marked the beginning of National Healthcare Decisions Week, a week dedicated to opening the door to the often challenging—but important—conversation of end-of-life planning. Created to “inspire, educate, and empower the public and providers about the importance of advance care planning,” National Healthcare Decisions Week encourages patients to plan for their own end-of-life care to hopefully improve satisfaction the patient and family’s satisfaction with care, reduce unnecessary hospitalization, and ensure timely hospice and palliative care use.
90 percent of people say talking to their loved ones about end-of-life care is important but only 27 percent have had the conversation. 80 percent say that they would like to talk with their doctors about their wishes for medical treatment toward the end of their life, should they be seriously ill, but only 7 percent have had this conversation.
So, how can providers help their patients prepare for this life certainty?
Reframe the conversation: End-of-life planning is not just for the elderly or the ill
Death is not easy to talk about, and each patient will have their own personal beliefs about what death means to them. Patients often feel that a conversation around end-of-life planning is only necessary when one is close to dying and talking about it before feels premature and morbid. But waiting until patients are facing the reality of death, it can often be too late.
Patients with more complicated cases are being referred to palliative care consultation, but often too late in disease process. Roughly 10 percent of Medicare patients who die receive at least one palliative-care appointment as they are often referred too late. While palliative care, by definition is targeted at a specific population, the reality is that it should span a lifetime, focusing on maximizing the quality of life and honoring a person’s wish no matter what stage of life they are in. Providers can help their patients plan for this important moment in their life when they are sentient enough to articulate their wishes on how they would like to die and who should be responsible for making decisions in the case they are unable to.
It’s important for patients to understand that planning in advance will reduce any potential conflict, ensure they are treated the way THEY want to be, and reduce costs.
Provide patients with the resources to start the conversation
Now that they are ready to have the conversation, where do they start? Encourage your patients to discuss this decision just as they would any other major life decision — with their family members and loved ones. Advance care planning is not just between the patient and the doctor, but is a larger conversation with people they trust.
There are numerous toolkits and conversation guides to help navigate the intricacies of end-of-life planning and prompt patients to answer questions like “What is most important to you?” and “Who would you want by your side during your last moments?” As these guides show, this kind of planning is rooted in honoring one’s wishes and helping to ease the pain of loss for their loved ones as they won’t be forced to make tough decisions without any guidance.
Below are resources to help start the conversation:
The Conversation Project
• Conversation starter kits
• “How-to” guides on choosing and being a healthcare proxy
• “How-to” guides for talking with your doctor
• Personal stories about the impact of advance care planning
Death over Dinner: Discussing advance care planning over dinner with family and friends
5 Wishes: Easy to use, legally binding
ClinicSpectrum Advance Directive Video: Simple video explanation of advance directives
Ensure their wishes are met
After the patient has created an advance directive with the help of their family and friends, it is important this is properly communicated to ensure their plan is implemented. These are very personal conversations to have and providers will need to make the time to properly manage this process. Better managing end-of-life care through honoring patient wishes and avoiding hospital deaths could save our healthcare system and our patients millions of dollars, with the current average cost of healthcare for patients in the last 12 months of life being about 4-5x that of an average patient.
There is much room for improvement in end-of-life planning and care. Are your patients prepared to make their most important decision?
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