The Common Sense Guide to Improving Palliative Care > Advance Care Planning > 3.8 Give Them Something to Talk About

This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Advance Care Planning: Give Them Something to Talk About

To give them something to talk about, get started. Here are a few key points to remember about Advance Care Planning (ACP):

1. Get started on the project, and do not wait for everything to be perfect.
2. Do not carry a lot of baggage from limited interpretations of your state's laws. This may require challenging overly restrictive institutional procedures.
3. Get feedback from patients and families to find out how you are doing and to get the boost that you may need to continue your efforts.
4. Do not just focus on CPR; instead, build ACP discussions around a good life, right up to the end.
5. Address the practical issues that your patients face, such as whom to call in time of need, which medication to take, and how symptoms will progress.
6. Use every crisis situation survived as an opportunity for rehearsing preferred options. Ask the patient and family (and professional care givers) what should have been done, and what can be done differently next time.
7. Avoid using medical jargon. Tailor your language to your setting and patients. "Artificial hydration" may not mean much to a 75-year-old spouse.

Frequently Asked Questions

What Should We Discuss When Deciding ACPs?

• Present the clinical situation, now and in the future, and options for the care plan in more than one way so as to ensure comprehension.
• Discuss the patient's health status and quality of life following treatment.
• When using medical technology, offer the use of time-limited trials rather than forcing a choice between "never" and "forever."
• Promise reassessment on a scheduled basis, and promise to stop if treatment is not helping.
• Listen to the patient, allowing time for him or her to respond and express wishes, fears, and concerns.
• Honor the search for meaning, treat symptoms, and ensure continuity.
• Set reasonable expectations for prognosis and treatments: what can your system promise the patient in the last years and weeks of life.
• Support families through all phases of illness, and plan for bereavement issues after death.
• Be capable of and willing to provide sedation for those near death if that is what the patient needs.