Where is Your Advance Directive?

Today is National Healthcare Decisions Day and, with it, a discussion revolving around end of life care and decision making. The Institute of Medicine recently published a report entitled “Dying in America” and, according to its study, less than 30 percent of Americans have discussed their end of life preferences with family members or their physician. The focus on end of life is not meant to be morbid; there is importance in making people feel comfortable conversing not only about how we live but how we die. The IOM report recognizes that Americans are not well informed about end of life care choices, and that physicians often don’t tie those options into their patients’ overall care plans. Recommendations include educating patients and physicians alike in how to communicate with each other on this issue, providing them with information on palliative care, and standardizing the advance planning approach.

In addition to the need for heightened awareness of advance planning, there is also the dilemma of where to store the advance directives.  A case was recently discussed in the New York Times in which a man had filled out an advance directive that indicated he was not interested in drastic lifesaving procedures. When an emergency occurred the form was not noticed until a week of lifesaving procedures had taken place.

Electronic copies of advance directives are the obvious solution, as they can be shared efficiently and as widely as one would like.  A problem is the lack of interoperability between providers.  Just because a primary care physician has a copy does not mean that the emergency room will have access to it.  Simply having an advance directive is not enough; the healthcare system needs to find a way to ensure that providers are utilizing them once patients are in an incapacitated state.  This will not only make tough decisions easier for family members, but it could make more cost-effective use of healthcare resources when patients opt for palliative treatment .

There is great value to be had in end of life care discussions. Providers and patients alike need to be properly informed on the benefits of palliative care and the importance of an advance directive. By coordinating care and working to improve the transfer of data between health systems we can ensure that the wishes of patients and their families are respected.