Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

3 Tips for Talking With Patients About Advance Directives


ALL clinicians can and should encourage patients to document their wishes regarding medical decisions in case they’re unable to make these decisions for themselves.

As a palliative care provider, asking patients’ families the question, “What would your loved one say if they were talking to me right now?” is inevitable. In the midst of their grief, exhaustion, and sleep deprivation, families are asked to make medical decisions who are unable to decide for themselves. We ask family members to somehow separate what they wish for their loved one from what their loved one is actually facing in reality. But, if they know their loved ones’ wishes in advance, they can simply follow directions without having to struggle with their best guess.



Sometimes patients prefer to write their wishes instead of talking about them. Advance care planning forms, like advance directives, are one way for patients to communicate their wishes for their future medical care. Whether it’s in written or verbal form, communicating their wishes is a gift they can give their loved ones to ease the burden of having to make difficult medical decisions as a surrogate.



No matter what specialty of medicine, all clinicians can and should encourage patients to document their wishes. Here are my top three tips for how to do this:


1. Just bring it up.

Often physicians hesitate to introduce advance care planning. They may worry that patients or loved ones will push back or lose hope. Instead, patients and families often welcome the opportunity to talk about their concerns. Similar to conversations about smoking cessation, simply introducing the concept increases the chance that patients will complete advance directives.



2. Reframe the purpose of advance care planning.

Sometimes patients or families view advance care planning as selfish. Patients may feel guilty thinking about their death. Families may feel guilty planning for their loved ones’ death. Instead, help people think about advanced care directives for what they really are—a selfless act of kindness that eases the burden of decision-making during a difficult time. It’s also a way for patients to ensure they remain in control when their disease takes many other things out of their control.



3. Help patients think of it more like guidelines.

Just like Captain Barbossa says in “Pirates of the Caribbean: The Curse of the Black Pearl,” ” . . . the code is more what you’d call ‘guidelines’ than actual rules . . . ,” advance directives can be thought of as a workbook. Because they are legal documents, people may be intimidated to complete them or to change them in the future. Encourage patients to review them regularly and change them if needed. This way, they are up to date and accurately reflect their wishes based on how the disease is affecting their quality of life at that time.