National Healthcare Decisions Day: Having Crucial Conversations With Patients For Advance Care Planning

Some of the most meaningful conversations I’ve had with my patients through the years have been about advance care planning. In the best of a trusting physician-patient relationship, these conversations can allow patients to think about how they would like to live their lives when they are near the end of their lives, possibly unable to make decisions for themselves at the time. These conversations contribute to patient autonomy and dignity, and can provide great relief to family members, who often struggle with guilt about what is best for their parent or spouse. 

But these conversations are hard, and they take time. Most people find it difficult to think about their own death, and the shift to the technical aspects of Code Statues, POLST forms, feeding tubes, intubation, CPR designated health care power of attorneys, and the like can be alienating and frightening for some patients. It has been my experience that some patients, if they have traditionally been from groups of people who experience discrimination, fear that expressing a “do not resuscitate” preference will mean that the health care system will “give up on them”, so it is very important that such worries are acknowledged and addressed. Data from oncology patients in palliative care indicate that cancer patient preferences for quality versus length of life and location of palliative care or place of death vary between individuals and evolve over time, underscoring that these conversations need to occur over time.

Advance care planning is a process that supports people at any stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care in order to make sure their medical care is consistent with their values and goals. It involves doctors, patients, their families or other surrogate decision-makers, and should be documented in the medical record in ways that can travel longitudinally with patients from one setting to another. Studies show that advance care planning improves multiple outcomes, including higher satisfaction with the quality of care, reduced hospitalization at the end of life, an increased likelihood that a patient will die in their preferred place, and for surviving family members, lower stress, anxiety and depression, as they feel better prepared to make decisions for their loved one.

National Healthcare Decisions Day, April 16, has been established in the United States to encourage everyone to pause and think about their healthcare wishes and to make them known. If we are able to do this successfully as a nation, we can move the politically charged conversations around “death panels” and “high costs at the end-of-life”, to one based upon how to alleviate suffering, respect and honor a patient’s wishes, and provide better care. 

At IKS Health, we are designing health care solutions that can help clinicians with these crucial conversations. Our Scribble Swift and Pro AI enabled with human-in-the-loop virtual scribes allow clinicians to focus on the patient in front of them, not a screen, have these crucial conversations, and have the patient’s wishes accurately documented as part of advance care planning. We believe that complete and compliant documentation for these important conversations is an important part of quality healthcare, and alleviates the burnout clinicians often face from documentation burden that may contribute to avoidance of this crucial work.

Authored article by Dr. Grace E. Terrell, Chief Medical Officer at IKS Health, a renowned healthcare innovator and serial entrepreneur specializing in population health outcomes. With a background in clinical informatics and a focus on value-based care models, Dr. Terrell has led numerous companies, written many books, and advises at Duke University and Oliver Wyman, holding a doctorate from Duke University School of Medicine.