Posted on: May 4, 2016
Written by: Coalition for Compassionate Care of California
Many providers have trouble initiating and engaging in advance care planning (ACP) discussions with their patients — and sometimes vice versa. But simple techniques and guidelines can help both parties buy in for improved care and increased practice revenue.
Providers often support the service but rarely perform it, so share these tips with your providers to get the ACP conversation started:
“I’ve done it myself.” Providers have a higher comfort level with ACP if they’ve made plans themselves, finds M. Jane Markley, founder of M. Jane Markley Consulting in Derwood, Md. Knowing a provider has done this for himself can make the conversation easier for the patient too, says Jennifer L. FitzPatrick, MSW, author of Cruising Through Caregiving: Reducing The Stress of Caring For Your Loved One and founder of Jenerations Health Education Inc. in Chester, Md.
“One of the most effective ways to approach this is by being able to tell the patient that ‘I have my own advance directives prepared,’” says FitzPatrick. “Frequently the doctor is much younger than the patient. Older patients then think, ‘wow, if my young doctor has it done, this conversation is not just because I’m old or because he or she thinks I’m about to die.’”
Ask all patients about advance directives. Make a policy of initiating ACP discussions with all adult patients. “When you go to the doctor, they ask your height, weight, whether you smoke, etc.,” Markley says. “The people I work with ask another question: Do you have an advance directive?” This makes the service “a routine part of preventive health care,” which makes it more likely patients will do it, she says.
Recommend that patients read about advance care planning. A huge body of literature on end-of-life issues has emerged in recent years, says Lael C. Duncan, M.D., medical director of consulting services for the Coalition for Compassionate Care of California in Sacramento. Some pieces are quite popular, like Atul Gawande’s books or the New York Times’ “New Old Age” column. “Some patients don’t have time to go read a book, particularly if the situation is acute, but other people who are still healthy and in the early stages of care planning can take advantage of books and internet resources to begin thinking about their values and goals,” says Duncan. “These conversations often take time and can be more productive when the patient and or family has had a chance to think in advance about some of the issues that need to be covered.”
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