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Understanding: an important foundation for Advance Directives counseling

Talking with a patient about Advance Directives is not easy. Broaching the subject of end-of-life care, and the need to spell out the need for sensitive decisions before they are necessary can by fraught with emotion, and uncomfortable at best.

But providers can and do understand that they play an important role in this process and make it a routine part of care for all patients.

Here are some of the best practices that providers have used successfully to make the completion of Advance Directives part of their patients’ health planning.

Before initiating the discussion, consider patients’ fears that will arise when discussing and filling out the Advance Directives forms. Be aware and prepared for the perception that some of the language in the documents is a barrier. For example, the terms “terminal” and “no hope of recovery” can increase patients’ anxiety.

Providers should consider the cultural, racial and ethnic factors that may have an impact on how patients perceive Advance Directives and end-of-life care. (You can find a good article on this subject here.)

Most successful Advance Directives interactions include repeated conversations over time, starting between 50- and 65 years of age during a routine office visit. Providers initiate a discussion of Advance Directives along with information about preventive measures, such as colorectal screening.

Many providers have found that group discussions of Advance Directives are more effective than individual intervention. It may be beneficial to present the information in a group setting, which stimulates discussion and questions. Additionally, a group discussion reduces the time commitment that many practices find is a barrier to Advance Directives discussions with their patients.

Regardless of the Advance Directives discussion format, whether individual or group, some providers have found that mailing an Advance Directive to the patient ahead of the appointment improves completion rates. Advance Directives information can also be found at the Oregon Medical Association’s website.