Healthy Aging Month has been celebrated in September since 1992. It has triggered many initiatives to help people live longer, healthier lives. This has meant that people have had the opportunity to plan for more milestones that bring joy and excitement — graduations, marriages, starting families, and embarking on new careers.
Longer lives can mean health challenges as well. Living life the way we want it to be, in sickness and health, is crucial. And yet, advance care planning is often overlooked, despite it being as important as the milestones in our lives. Advance care planning allows individuals to make informed decisions about their own medical treatments and end-of-life preferences while they still have full capacity to do so. While it’s important on an individual level, this patient-centric type of care is at the basis of a strong population health strategy.
Your role as clinician
Thinking about our own mortality and potential future incapacity can be very uncomfortable. Yet, as clinicians we need to ask our patients to confront these difficult subjects, and to make decisions, document them, and be sure we have copies of any decisions in their medical records.
As clinicians, you can play a pivotal role in facilitating advance care planning. You can start the conversation at any office visit, but most appropriately during the annual wellness visit or when a new diagnosis arises.
Advance care planning is a separately billable service for all of our member’s plans and may be subject to a member’s cost-share. For our Medicare members, review our Preventive Services reimbursement policies (EmblemHealth | ConnectiCare) to see when cost-share waivers apply.
To make the most of your discussions, actively listen to your patient’s concerns and offer support throughout the process. You are the patient’s advocate when it comes to respecting their preferences. Here are some tips for having advance care planning discussions:
- If you have the option, consider whether the exam room or your office is the better location to address the topic. Ask permission to start the conversation.
- Assess what the patient and family already understand about their health challenges and diseases they need to manage so you can fill in the gaps.
- Be empathetic; speak in simple language using short sentences, especially when giving updates or a prognosis about a disease or condition.
- Take breaks and allow for silence so they can process what is being said. Remember, this may be a daunting experience for them.
- Ask about the patient’s and family’s goals, fears, challenges, and the barriers they are worried about.
- Ask for questions and feedback.
- Briefly summarize the discussion and set specific recommendations about their next steps.
We recommend encouraging your patients to initiate planning discussions with their family and/or friends while they are still able to make decisions and define their needs and wants regarding their futures. The U.S. Department of Health & Human Services’ National Institute on Aging has a comprehensive conversation guide you can share with your patients. It will explain their options for documenting their wishes, from a simple health care proxy to a living will or more detailed medical orders for life-sustaining treatment (MOLST).
See more resources available to you and our members on our new MD Perspective Programs, Classes, and Resources page.