Hear from the Doctors
|Michael J. Green, MD MS||Benjamin H. Levi, MD PhD|
|Penn State University Hershey Medical Center||Penn State University Hershey Medical Center|
As practicing physicians as well as experienced ethics consultants, we know how challenging it is to take care of seriously ill patients who have not communicated their wishes in advance. We also know that advance directives need to be specific enough to be helpful, but general enough to accommodate a variety of situations.
We know that doctors need a tool that helps patients clearly explain what matters to them and how it should apply to medical decisions in the event they cannot speak for themselves.
Early in our training, we noticed that many patients never prepared themselves or their loved ones to make the medical decisions that often need to be made at the end-of-life – and that this often had tragic consequences.
We quickly came to appreciate that standard living wills did not solve the problem –because they failed to promote the kind of discussion that patients need to have with their doctor in order to make informed decisions, and with their loved ones to make sure everyone’s clear about what matters to them and what they’d want done.
We’ve been discussing how to address this issue for over 20 years. And for the past dozen years, we’ve been working with our sleeves rolled up to create a clinically useful online tool for helping patients and their doctors engage in advance care planning.
How did you get
Why advance care planning is best done with physicians.
Our unique use of
A structured approach to jump start the conversation.
Helping patients have a productive conversation with their physicians. (0:57)
Key factors in creating a clinically relevant Advance Directive.
A physician's assistant to prepare patients for the conversation
What is the most important part of advance care planning?
The tool includes a decision aid that helps patients clarify their goals and wishes, and prepares them to talk with doctors and loved ones about medical decisions that may need to be made. It also uses videos and interactive exercises to walk people through issues they often find confusing, as well as create a personalized advance directive document that can be shared with others and used as a starting point for difficult conversations.
Our extensive research has shown that patients find this tool to be easy to use, and that the advance directive it generates accurately expresses their values and wishes – without raising anxiety or taking away hope. We’ve also found that when doctors use this tool they make decisions that better reflect what patients would want.*
So, take the next step now, and have a conversation with your patient. It’s good medicine.
* Select Citations
M Green, J Schubart, E Farace, M Bain, E Lehmann, BH Levi. Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients with Advanced Cancer: A Randomized Controlled Trial. Journal of Pain and Symptom Management, 2015; 49(6):1088-1096.
J Schubart, F Camacho, MJ Green, K Rush, BH Levi. Assessing the Internal Consistency and Temporal Stability of Advance Directives Generated by an Interactive Online Computer Program. BMJ Supportive and Palliative Care, 2015 Mar 5. doi: 10.1136/bmjspcare-2014-000814
BH Levi, S Heverley, MJ Green. Simulated End-of-Life Decision Making: Accuracy of A Decision Aid for Advance Care Planning. Journal of Clinical Ethics, 2011;22(3):223-38.