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How to Start a Hard Conversation: Engaging Patients in Advance Directives

Monday, March 30, 2015
Diana Dilger
Co-author: Diana Dilger, Senior Writer, Emmi Solutions

No one likes to bring up death. People like it even less when it’s about them. But that’s not a good reason to avoid it. It’s an important discussion, and we have a responsibility to promote these conversations so patients can have a say in what they do and don’t want.

How do you bring it up?
First, if someone isn’t seriously ill, bringing up advance directives (AD) can seem jarring and out of the blue. It can help to ease into it by saying things like, “Since everything looks good now, this would be a great time to talk about what you might want if you ever do need something and can’t speak for yourself.” Or normalize it: “It looks like you don’t have AD on file. We try to have those for everyone in case you’re ever in an accident; it’s a great safeguard.”

For people who are ill and know something could happen, it might sound more like, “We have your treatment planned for now, but let’s talk about what you may or may not want if treatment doesn’t go the way we hope.”

Then, explain how ADs are a gift to their family. If someone is in an accident or becomes unable to speak for themselves, and there aren’t ADs, it can create a lot of stress, guilt, disagreement, and confusion for their family. So getting it down in writing and alerting everyone to what they want in advance can be a big relief. It's like leaving a guide book for their loved ones.

Address Common Concerns
People are afraid once they create ADs, they’re locked into them. Letting people know they can change them at any time if their wishes change puts people at ease. It also helps to emphasize that putting an AD in place does not mean they’ll get less care. Instead, saying what they do and don’t want helps ensure they’ll get the care they prefer.

National Healthcare Decisions Day
April 16 is dedicated to encouraging people to discuss and document advance directives.
Check out all the events going on for National Healthcare Decisions Day.

Help Everyone Understand
To help educate the public, the multimedia Advance Directives Emmi program will be freely available to the public for two weeks, starting April 16. View it here.

Learn from Experts
A complimentary webinar on with Dr. Ira Byock and Dr. Sheri Kittelson on
Engaging in End of Life Decisions: How to Turn Difficult Conversations into Clinical Opportunities
11 am Central on April 16. Sign up here.


Diana Dilger is a senior writer at Emmi Solutions. She wrote the multimedia Emmi programs on advance care and end-of-life treatment (Advance Directives, Hospice Treatment Options, and Palliative Care). In addition to encouraging others to talk about end-of-life wishes, she boasts a shiny, new set of advance directives for herself. @dianadoesthis


Tags: communication, end of life
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