Advance care planning: do’s and don'ts

Don’ts

Do’s

Don’t wait until the very end of life to have the conversation, when the situation is often chaotic and stressful.

Do initiate the discussion early, preferably before the patient is critically ill, when the conversation will be easier.

Don’t call it an “end-of-life” discussion.

Do call it “advance care planning.”

Don’t enter these conversations cold.

Do practice what you will say (for example, by role-playing with a colleague).

Don’t delegate too much. CMS expects the billing physician or other provider to manage, participate, and meaningfully contribute to the provision of these services.

Do involve others as appropriate (e.g., your staff can fill out the forms).

Don’t skip the documentation.

Do document that the conversation was voluntary, summarize what you discussed, explain advance directives, record the length of the conversation, and note who was present.

Don’t rush the conversation.

Do be prepared to spend as long as necessary to discover and record the patient's wishes.

Don’t feel pressured to have this conversation with every patient.

Do identify patients for whom this discussion is a priority. For example, ask yourself if you would be surprised if the patient died in the next year. If your answer is “no,” then have the talk.

Don’t force the conversation if the patient isn’t ready or needs time to reflect.

Do start the conversation by asking if the patient has any documents already prepared, has talked to anyone else about advance directives, and would be comfortable sharing how they feel.