Ninety percent of people say that talking with their loved ones about end-of-life care is important, but only 27 percent have actually done so, according to The Conversation Project, an organization dedicated to getting people talking about end-of-life care.
And while 60 percent of people say that making sure their family is not burdened with tough health care decisions is extremely important, 56 percent have not communicated their end-of-life wishes.
“We also know that the completion of advance care directives nationally is abysmal,” said Dr. Lynda Tang, a palliative care specialist at The Vancouver Clinic. Only about 30 percent of people have such paperwork in their medical record, she said.
Those kind of statistics are why Tang hopes to be begin a conversation about advance care planning among her colleagues and the community.
“If the paper isn’t being turned it, let’s push the conversations,” Tang said. “You should really be having these discussions in your living room, not at the hospital.”
Advance care planning is different than advance care directives. Directives are legal documents that outline specific medical interventions that a person would, or would not, want to receive, or designate a specific person to make such decisions on their behalf.
“Planning signifies the process, the conversation,” Tang said. “It happens over time. It’s not a one-time thing.”
Instead, advance care planning encourages people to continue to have discussions about what type of medical treatments and interventions they would want to receive in the case of emergencies or terminal illness. A person’s life changes over time, perhaps altering their perspective on interventions, Tang said.
“Things that are important to you at 28 are different when you’re 82,” she said.
Someone who is 28 may not want to live if it means being confined to a wheelchair, Tang said. At 82, that person may be OK with life in a wheelchair as long as they get to have more time with grandchildren, she said.
“Everybody has that line, that boundary of quality of life,” Tang said.
If family members — and medical providers — don’t ask about those boundaries, they won’t be equipped to meet the person’s desires, she said.
That’s why Tang spearheaded an effort at The Vancouver Clinic this month to get all staff thinking and talking about advance care planning and end-of-life decisions. Earlier this month, Tang asked her colleagues to pledge that they would begin having those difficult conversations with their family members. More than 700 of The Vancouver Clinic’s 1,328 employees made the pledge, Tang said.
The effort was in recognition of National Healthcare Decisions Day, a day to empower the public and providers about the importance of advance care planning.
“It’s important to us so we’re going to model it,” Tang said.
“We have every opportunity and motivation to get our patients ready for these conversations,” she added.
Even people who have already completed advance care directives or living wills can benefit from continuing the conversations with their loved ones, Tang said. Not only because their wishes may have changed, but they may learn that their family members aren’t willing or able to follow those wishes, she said.
“Even though we’ve designated people to speak on our behalf, we have to have those conversations,” Tang said.
“If you haven’t started a conversation, start it,” she said. “If you’ve started a conversation, keep talking about it.”