How to Have an End-of-Life Conversation

Communicating with Seniors

end of life planning
It is important to think about and plan for your end of life wishes. It assures your peace of mind and your familiy will benefit from knowing what you want. Getty Images

A national survey in 2013 found that 90 percent of Americans believed it was important to have end-of-life care discussions, yet less than 30 percent had done so. At UnityPoint Health, a network of hospitals, clinics, and home care services in Iowa, Illinois and Wisconsin, our goal is to change that. We encourage patients and their loved ones to start having these conversations well before end-of-life care, which may include palliative care and hospice as needed.

UnityPoint at Home, a division of UnityPoint Health, provides resources and services related to hospice care, palliative care, adult and senior home care, and more. Our palliative care program, which began in 2005 at the request of patients and their families as well as the medical community, positioned our integrated team of health care professionals to nurture end-of-life conversations early and often. Over time, UnityPoint at Home’s integrated approach has helped individuals with serious illness to discuss their goals of care, improve quality of life, enhance patient and family satisfaction, and help the patient receive the right level of care at the right time.

We understand having this type of conversation about possible health care choices in the future is never easy, but discussing what is important to you with your loved ones early can help your medical team better honor your wishes.

Getting Started

Talking with loved ones is the most important way to prepare and plan. There are many ways to begin the conversation.

  • Some may feel more comfortable writing a letter that shares their thoughts.
  • Others may prefer to formally schedule a time to meet when they decide whom they want to have the conversation with.
  • Feel free to also consider a more natural transition.

For example, "I was thinking about what happened to Sally and her family recently, and it made me realize that I’m not sure if you know what I would want in a situation like that. Can we talk more about it?”

Topics to Consider for Discussion

Planning ahead and preparing for the future involves discussing a number of considerations that include health, legal, financial and other related matters.

Health

  • Current doctors and contact information
  • Current medications and treatments
  • Current pharmacy and contact information
  • Comprehensive medical records

Legal

Advance directives: A legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. Advance directives may include:

  • Health care proxy (durable power of attorney for health care)—Identifying an individual(s) that will make health care decisions for you when you are no longer able
  • Living will—A document where you state your wishes about your medical treatment preferences.
  • Trust arrangement—Formal agreement through which a trustor vests ownership rights to one or more assets to a trustee for protection on behalf of any beneficiaries of the trust

Financial

  • Completion of a will
  • Durable power of attorney—May be necessary to have for property matters; make sure to communicate future plans and finances
  • Estate planning, funeral planning
  • Insurance policies review
  • Medicare and Medicaid policies

Questions to Consider

  • What matters most to you at this time of your life?
  • Do you have any goals or wishes you would like to have met?
  • Do you have fears about living with a serious illness?
  • Whom do you want to share your decisions with? Whom would you trust to honor your wishes if you were unable to make decisions?
  • Do you understand your health care choices?
  • What do you need to ask your health care providers about your condition?
  • How active would you want to be in your health care decisions?
  • What are your thoughts on life-sustaining treatment?
  • Is there a point when you would you no longer want to receive curative treatment or comfort care?

Remember, these suggested questions and topics will help you get started but are not comprehensive. Consider talking to your health professional about the local support available to you and your loved ones to help you with advance health care planning. Once you have completed your plans, you will want to review them and be sure that they continue to reflect your wishes over time. Having the conversation about your health care goals is truly a gift you can share with your loved ones. For additional resources to help you manage end-of-life care decisions, visit the National Hospice and Palliative Care Organization.

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