Advance Care Planning: Making Your Own Decisions about the Care You Will Receive

By: Maudette Carr, MSW, Social Worker

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In my work as a social worker for Advocate’s Home-Based Palliative Care Program, I am part of a team that provides care for patients with serious, progressive illnesses or chronic diseases. These patients have been referred to palliative care for help in managing their symptoms and addressing their emotional, social and spiritual needs. Helping patients understand their conditions and their choices for medical care is also a vital part of palliative care. My responsibilities on the team include working with patients and their loved ones on advance care planning (ACP)…coming to understand, discuss and plan for a time when the patient may not be able to make his or her own medical decisions. In my experience, the best way to open the dialogue about ACP is to ask patients about their goals of care. I don’t pull out the forms or mention terms such as advance directives or power of attorney, at least not at first. Instead, I engage the patient in talking about the current care plan, and then move on to talk about a time when they might be unable to make decisions themselves. I will ask, “What do you want?” Many times, my patients have expressed to me how grateful they are for the opportunity to make their own choices. In many cases, this is the first time they have been asked to think about what they want without input from their doctors, their friends, or their families. Of course, it’s always useful to have a loved one present during this discussion. The person who will be asked to execute the patient’s wishes must acknowledge that “yes…I will be able to abide by these guidelines.” If not, another person will be asked to serve in this role. In my experience, talking about choices is an empowering moment for our patients and can lead to thoughtful consideration about the future. That’s what ACP means, planning for your future. I’m proud that Advocate Health Care has made a strong commitment to ACP discussions, and has trained many professionals who, like myself, work with patients and families to advance this important initiative.