How do you engage patients and families in advance care planning conversations?

1 Understand the benefits of ACP

ACP can benefit patients and families in many ways. It can help patients express their wishes and values, reduce anxiety and stress, enhance quality of life, improve communication and trust, and prevent unnecessary suffering and burden. ACP can also help families respect and honor the patient's choices, cope with difficult decisions, and support each other. ACP can also help healthcare providers deliver patient-centered and appropriate care, avoid ethical dilemmas, and align their recommendations with the patient's goals.

2 Assess the readiness of patients and families

Not all patients and families are ready or willing to engage in ACP conversations. Some may have cultural, religious, or personal beliefs that make them reluctant or resistant to talk about death and dying. Some may have emotional or cognitive barriers that prevent them from understanding or accepting their prognosis or options. Some may have conflicting or unrealistic expectations or preferences that need to be addressed. As a patient advocate, you can assess the readiness of patients and families by asking open-ended questions, listening actively, and observing their verbal and non-verbal cues. You can also use tools such as the Readiness Ruler or the SPIKES protocol to gauge their level of interest, knowledge, and motivation for ACP.

3 Build rapport and trust with patients and families

ACP conversations require a high level of rapport and trust between patients, families, and healthcare providers. As a patient advocate, you can help build rapport and trust by showing empathy, compassion, and respect. You can also use techniques such as mirroring, paraphrasing, and reflecting to demonstrate understanding and validation. You can also use positive reinforcement, affirmation, and appreciation to encourage and support patients and families. You can also use humor, stories, and examples to lighten the mood and create a comfortable atmosphere.

4 Use appropriate communication skills and strategies

ACP conversations involve sensitive and complex topics that require effective communication skills and strategies. As a patient advocate, you can use communication skills such as asking open-ended questions, using plain language, avoiding jargon and acronyms, providing clear and accurate information, checking for comprehension, and summarizing key points. You can also use communication strategies such as motivational interviewing, shared decision making, and goal setting to elicit and explore the patient's values, preferences, and goals, and to facilitate agreement and action on ACP.

5 Provide relevant resources and support

ACP conversations are not one-time events, but ongoing processes that may change over time. As a patient advocate, you can provide relevant resources and support to patients and families throughout the ACP process. You can provide information on ACP options, such as living wills, health care proxies, advance directives, and POLST forms. You can also provide guidance on how to complete, update, and share these documents with healthcare providers and loved ones. You can also provide referrals to other professionals or services that can help with ACP, such as palliative care, hospice care, social work, chaplaincy, or legal aid.