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Article

Discussing End of Life Wishes with Your Doctor

By Rita Dichele

Everyone at some point in time has a face-to-face conversation with their health care provider.  Even though this should be considered simple enough, it can be very difficult depending on what generation you belong to.  Seniors older than Baby Boomers were brought up with the idea that you addressed your physician by “Dr.” and that essentially you were the patient who remained silent, if you will, during office visits.  It was unheard of to challenge your doctor, let alone ask too many questions. However, today these ideas of physicians as “all knowing” have changed.  Patients are more consumer-orientated and want to get the most out of their office visits, not only to gather health information but for financial reasons as well.  On the other hand, medical students are being trained to be more sympathetic and empathetic to their patient needs.  Hence, medicine has changed in terms of physician and patient expectations. With that being said, it can be intimidating to have an end of life conversation for both the patient as well as for the physician.  In fact, some physicians are getting training in how to approach an end of life conversation.  So, you can just imagine how the doctor might be feeling about this! Placing the physician’s feelings aside, it is important to remember that you have formulated a partnership with your physician to keep you healthy. Here are some useful tips that you might want to consider for yourself and as a family caregiver. Plan ahead Because time can be limited, ask the doctor upfront how long the office visit will last.  Keep in mind, however, that Medicare does allow up to 30 minutes for end of life planning.  Once you get the timeframe out of the way, relax and don’t let anything rattle you.  Remember, the physician might be just as anxious as you are or possibly more. On the day of the visit, have a priority list of questions or concerns.  Make sure that this list has been made in advanced, weighing all issues by order of importance. Documentation Make sure the physician has a copy of your living will and/or health care proxy form. Tell the physician that you want to sign a medical information release form indicating what persons you want to know about your medical situation.  By completing and signing this form, it will alleviate some of the stress you could have later regarding who should have access to your medical information.  This form also is helpful when an individual is hospitalized. Discuss with the provider the Physician Order for Life Sustaining Treatment (POLST).  As I have mentioned in previous end of life articles, the POLST form is not a prescription to die, an act of euthanasia, or a physician assisted suicide.  The purpose of the POLST form is typically for individuals who are nearing the end of their life and are most likely under the care of hospice.  Having this type of documentation in place, will let everyone involved in your care or your loved ones know what type of life sustaining treatments you do or do not want.  For instance, do not resuscitate (DNR), no feeding tube, do not hospitalize, etc.  There are many more listed, but these are the name of a few.  However, every life sustaining treatment is important, so please make sure you fully understand them.  With that being said, understanding POLST can be tricky.  This is the time to ask a lot of questions, as these are extremely important.  THE POLST form will subsequently become part of the medical record.  However, you always have the right to change your mind if you are conscious.  As I have said previously, advanced directives, although legal documentations, can be changed as long as individuals are conscious and in their right state of mind. What to Wear This might sound silly, but wear comfortable clothes.  You want to be focusing on your conversation not tight shoes.  If you wear glasses, make sure that you bring them along.   Also, if you wear hearing aids make sure you wear them.   If you are accompanying a hard to hear loved one, make sure they wear them.  Nothing would be worse than having this important conversation and not being able to hear it.  Let’s face it; it can be annoying for others to be repeatedly told to speak up.  Unfortunately, this can take up valuable time. Don’t Go Alone By all means bring a trusted family member and/or friend.  I would recommend limiting it to one person.  After all, you do not want to overwhelm the provider.  Ask your trusted person to remain for the most silent unless they feel you have forgotten something important.  Also, you might want to rehearse with this person beforehand so that you will be assured that the visit will be productive.  It is always acceptable to bring someone into your office visit.  Your provider will ask you for permission to talk in front of him or her. When you Leave Ask the doctor if all the pertinent information related to your end of life discussion will be scanned into the electronic medical record.  This is very important. I would recommend thanking the doctor for his help in this delicate matter.  I would also recommend asking the doctor if he/she can be contacted by email and/or phone should you have any more questions.  With electronic medical records, providers are now able to communicate with their patients and family members via email on a secure site. After that, you can take a sigh of relief that the conversation has ended. Final Remarks Please keep in mind that end-of-life care is NOT a mercy killing or a form of euthanasia nor is it physician assisted death.  End of life care does not mean a person’s premature death.  Your loved ones die a natural death. There are many ways to communicate end of life care.  This is a series of blogs that will help caregivers understand in greater detail how to meet the needs of their loved ones as they approach death. Rita Dichele holds three Master degrees in Counseling Psychology, Health Care Administration, and Human Services.  Ms. Dichele is certified in death & dying and bereavement from the Association for Death Education and Counseling (ADEC).  She is on faculty with A.T. Still University and instructs classes in grief work and long-term care.

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An Update on NCAA's Creative Caregiving Guide

October 11

eCareDiary's caregiving expert, Margery Pabst Steinmetz will speak to Dr. Greg Finch, Field Services Director at The National Center for Creative Aging, Dr. Vanessa Briscoe, Professor at Bethune Cookman University and Tamika Harris from Share the Care about new developments involving NCAA's creative caregiving guide aimed at improving the quality of caregivers' lives.

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