Tips on How to have Important Conversations with Loved Ones about Care Wishes
By James Mittelberger, M.D., Director and Chief Medical Officer, Optum Center for Palliative and Supportive Care
According to a national survey by the National Hospice and Palliative Care Organization, more than 90 percent of people think it’s important to talk about their loved ones’ and their own wishes for end-of-life care, but fewer than 30 percent of people have actually had the conversation. Many people simply haven’t gotten around to taking the necessary steps to crystallize what they want and to formalize it. Sometimes it’s because people don’t know how to start the conversation with their loved ones.
As a physician, I have seen how advance care planning conversations and completing advance directives change the experience for a patient and their loved ones. It may feel a bit uncomfortable to get started, but rewarding conversations with family members today can assure medical care preferences are honored while reducing stress and uncertainty in the future.
A great way to start is by thinking about what is most important to you if you were facing a life-threatening or serious illness and could not convey your wishes. Start reflecting on what you and your loved ones would want, express those desires, and have a thoughtful conversation. After all, no one wants to be guessing about what a loved one would want should a difficult decision need to be made.
Here are some simple steps to begin the conversation and planning for important end-of-life health care decisions:
- Start with your loved ones. Honest communication can help families avoid the stress of guessing what a family member would want. You may find that you and your loved ones may see some things differently. That’s okay. It is most important that your loved ones know how you want to be treated and are willing to respect your wishes. Decide who you prefer to make decisions on your behalf in case you are unable to express your choice.
- Think about what is most important to you. What are your greatest fears, hopes and goals? What do you most care about? Most people can be effectively treated for pain, but how much do you want to be at home; or avoid being on a breathing machine; or being dependent in a nursing home? How sure are you of your choices? Do you want your chosen proxy to have leeway to change your decisions? Discuss these topics with your loved ones to reach a shared understanding of your desires.
- Use the resources available to get better informed and be sure to discuss your choice with your health care providers. You can find valuable resources to help you and your loved ones make decisions more manageable at prepareforyourcare.org, theconversationproject.org, and agingwithdignity.org.
- Make it official. Once you’ve had the conversation, it is essential to formalize your decisions by putting them in writing. Complete an advance directive. Special medical orders can be developed with your doctors to represent your care decisions for providers. Finally, assigning a health care proxy or agent identifies the person you trust to act on your behalf if you are unable to make decisions or communicate your wishes. Be sure to share your documents with your providers and your proxy, and to have copies available in case they are needed.
This is something that takes time, but can be a rewarding experience. I have seen firsthand the sense of peace, calm and satisfaction families experience when they are talking about what is important and knowing their loved ones wishes are or will be followed.
Dr. James Mittelberger is the Executive Director and Chief Medical Officer of Optum’s Center for Palliative and Supportive Care. Optum’s Center for Palliative and Supportive Care brings together industry experts and Optum capabilities to lead the advancement of palliative and supportive care to ensure every patient facing serious illness lives their best possible life.