Advanced Practice

Your Role in Your Patients’ Advance Care Plans

National Healthcare Decisions Day (something of a misnomer, since it’s been extended to an entire week this year) serves as a means of initiating often difficult conversations between Americans, their loved ones, and their healthcare providers, about living wills, end-of-life directives, and other types of advance care decisions. It’s understandable why many view such undertakings with trepidation, whether due to fear of death, or simply assuming it would be too much of a hassle. As a result, as many as three quarters of Americans don’t have some form of advance directive, including as many as one quarter of people aged 60 or older, for whom they are most crucial.

While this is dangerous enough for patients themselves, what many often overlook is that it makes healthcare professionals’ jobs much harder when their patients haven’t taken the time to sufficiently plan and organize advance directives. From hospice caretakers to EMTs, you know how messy things can get when a deteriorating patient in need of critical care comes in without one. Vainly attempting to ascertain wishes from nearly unconscious patients, arguing with multiple harried family members with conflicting opinions on the best course of action, being pressured to do something that might violate your ethical standards – basically, it’s just like your average family Thanksgiving, except in this case your patients’ lives—and even your own career—could be at stake.

Therefore, even if it’s only for purely self-interested reasons, it’s critical that you as a healthcare professional encourage your patients to take the leap and prepare advance directives. Here are a few ways you can help catalyze that process for reluctant or underinformed patients.


The first step, perhaps obviously, is to inform your patients exactly what advance care plans entail and why they’re important to have. Indeed, one reason why patients might not have proper advance care plans is a simple lack of research – they might not know exactly what they are or how to compile them in a legally binding manner. Don’t be afraid to initiate a conversation about this – it might be uncomfortable at first, but hey, you didn’t get into medicine for comfort, did you? Lay out in simple terms what advance directives are for, and make sure your patients know about free online legal services like RocketLawyer that make compiling living wills and other documents a lot easier than they probably think it will be.

Collaborate with patients

Once you’ve gotten the ball rolling, don’t just leave your patients to their own devices – offer your expert guidance during the process of crystallizing and certifying their advance care plans. Answer any questions they have about the potential consequences of any decision they make and encourage them to be as specific as possible. This collaboration will benefit both parties. First, it will grant you the opportunity to steer patients toward making plans that are in line with your medical and ethical standards, preventing issues later when it actually comes time to implement them. Second, it will help assuage any concerns your patients may have about healthcare providers overriding their wishes, simply by virtue of the fact that you helped them craft those wishes and thus have something of a stake in making sure they are carried out.

Involve families

Don’t just work with your patients alone, though. Make sure the family members and loved ones who will be involved in carrying out their advance care plans are also involved in the process. Help each patient select a reliable and clear-eyed power of attorney, and make sure that person knows exactly what they’re signing up for. Get the rest of the family on board too – all it takes is one dissenter to create chaos in an already stressful critical care or end-of-life situation.

Encourage preparation

Even the most detailed and legally airtight advance care plans aren’t worth much if a patient’s caretakers aren’t aware of them. Encourage your patients to distribute their directives to and discuss them with all their relevant healthcare providers – primary care physicians, nurses, specialists, emergency caretakers, all of them. Furthermore, impress upon them the importance of making sure their directives are accessible at a moment’s notice in the event of an emergency, even if that means advising your most vulnerable patients to carry them around. Maybe stop short of sanctioning “DNR” tattoos, though. 

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