Discussing advanced care planning proves difficult for most. Even doctors, some of our most trusted guardians for healthcare decisions, do not always feel comforatble starting these conversations. So why is it so troublesome? For a variety of reasons:
"Perceived difficulty of prognostication, uncertainty about how best to communicate with patients and families with diverse communication needs, and inadequate time to have them — not to mention the troubling emotions that talk of death raises for both patients and physicians..."
So when is it best to have these discussions? Doctor Justin Sanders contributed to the New England Journal of Medicine 2015 article Finding the Right Words at the Right Time — High-Value Advance Care Planning, that they are best approached in patients with life-limiting illnesses, whose decision-making capacity could be compromised at some point in the not-too-distant future. Hence, hospice patients are especially important to have these discussions with.
Perhaps having the discussion today won't be easy. Talking about death acknowledges that it happens, and eventually it will happen to us. It is crucial for clinicians in the field to become comfortable starting these conversations. If not us, then who?
Sanders, J. (2015). Finding the Right Words at the Right Time — High-Value Advance Care Planning. New England Journal of Medicine, 372(7), 598-599. doi:10.1056/nejmp1411717