The Journal of the Arkansas Medical Society Issue 12 Vol 114 | Page 12

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EDITORIAL PANEL
Chad T. Rodgers, MD, FAAP; Elena M. Davis, MD, MPH;
Michael Moody, MD; J. Gary Wheeler, MD, MPS
Proactively Ask
About Care Preferences
BY KIMBERLY GARNER, MD, JD, MPH;
and JAMIE JENSEN, LCSW
Imagine one of your patients,
hospitalized for several weeks with
a life-threatening illness, is now
unable to communicate their care
preferences. Do you know what
is important to your patient?
R
egardless of their age or health
status, you should proactively
and routinely ask your patients
about their care preferences. Life-
threatening illness or injury can
happen to anyone at any time. Your
patients should be encouraged to
regularly reflect on their values,
communicate with those they trust
and document preferences for future
medical care. 1,2 Research indicates
that patients who plan 3 for these
challenging decisions are more likely
to receive care that is aligned with
their values and goals. Planning also
relieves stress, anxiety and depression
for their decision makers. 4
Your patients can utilize a statutory
legal document called an Advance
Directive (AD) to document their
preferences. One free version of
this document is on the Arkansas
Department of Health website
under Health Care Decision Forms
(https://www.healthy.arkansas.
gov/programs-services/topics/
health-care-decision-forms).
This document, like most ADs,
has two parts, both of which are
important. Your patient can choose
to complete either one or both:
• A Durable Power of Attorney
for Health Care (DPAHC) allows
patients to appoint a trusted,
surrogate decision maker if
they become unable to make or
communicate their own decisions.
• A Living Will allows patients to
document specific care preferences
to serve as guidance to their health
care provider(s) and surrogate
decision maker.
The nature of these conversations
will vary depending on whether they
are healthy, have mild to moderate
chronic illness or have a life-
threatening condition. 1,2
Regardless of their health status,
it’s a good idea to routinely ask if they
are willing to have this discussion.
• If they are not ready, tell them
this is important and that you will
ask them again in the future.
• If they are ready, a good way to
start the discussion is to ask:
“Can we talk about whom
you would want to make
decisions for you, if you were
ever seriously ill or injured?
• Your discussion should also
involve the challenges that
surrogates face in making difficult
decisions for someone else:
“Who could advocate for you in a
medical setting? Who can get your
care preferences achieved, even if
it is not what others are wanting or
expecting to happen?”
• If your patient appoints more
than one surrogate, ask who will
be the primary and if surrogates
disagree, how that should be
handled. You should also discuss
how much leeway your patient
wants a decision maker to have.
For example:
“How would you want your
surrogate to follow your guidance
… follow it exactly or use their own
judgment? What if your surrogate(s)
disagrees with your preferences?
What if other family members or
friends disagree?”
• If your patient is not healthy,
it is critical to establish your
patient’s understanding of his
or her current health status and
what decisions may have to be
addressed. This will help you
understand what information or
guidance you need to provide
THE ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. (AFMC) WORKS COLLABORATIVELY WITH PROVIDERS, COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO PROMOTE THE QUALITY
OF CARE IN ARKANSAS THROUGH EDUCATION AND EVALUATION. FOR MORE INFORMATION ABOUT AFMC QUALITY IMPROVEMENT PROJECTS, CALL 1-877-375-5700. • JUNE 2018
276 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 114