Many times, when patients are asked about their wishes at the end-of-life, they perceive it as asking how they want to die, which can be scary for patients and a hard conversation for nurses. What if there was a way to change that conversation to suggest that it is way more about how the patient would want to live? In her session “Advance Care Planning: It’s About Life,” on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Erin Dickman explained how the advance care planning process can help nurses hold those conversations.

Advance care planning is a process of multiple conversations between patients, their families, and healthcare providers about future wishes and priorities for care. It helps patients contemplate their future, consider their sense of purpose and core values, catalyze deeper communication with their loved ones, and regain the power to ensure that their needs and preferences will be honored when it matters most. Patients can view it as a gift to loved ones and a way to dispel any confusion about their wishes regarding end-of-life care.

How to Have an Advance Care Planning Conversation

  1. Start by asking your patients open-ended questions like, “How have you been coping with your illness?” “How would you describe your quality of life?” or “What brings joy to your life?”
  2. Ensure all members of the healthcare team share a common understanding of the goals and processes involved in advanced care planning. Nurses can lead the way by educating patients and promoting a uniform message.
  3. Encourage and facilitate advanced care planning conversations with patients and their families wherever possible. This is something that should be recommended to all adults, regardless of age or health status.
  4. If patients are in an intensive care unit or seriously ill, confirm that all team members know their advanced care plan status and that it is clearly documented. If it’s not, start the process.

“Advance care planning is a process and will take each person a different amount of time to complete,” Dickman explained. “Keep in mind that these are fluid conversations and documents and can change based on patients’ evolving priorities.”

How Nurses Can Model Through Their Own Advance Care Planning

One of the best ways to be able to teach others about advance care planning and guide patients through the process is for nurses to do their own advance care planning, Dickman said. She provided the following steps to get started.

  1. Reflect on your wishes, priorities, and values by asking yourself these questions.
  2. Write them down.
  3. Share them with your loved ones.
  4. Select your healthcare proxy or power of attorney that will speak for you if you cannot speak for yourself.
  5. Talk to your primary care physician about your wishes, priorities, and values.
  6. Fill out your state-specific advance directive.

For more information, ONS also has a helpful video resource about advance care planning.