End of life decision-making : preparing an advanced directive

Most Americans will die in a hospital or skilled care facility. Despire diligent efforts by local citizens groups, state and national foundations, and healthcare providers to inform the public about their legal rights, only 15% of patients have advanced directives in the form of a living will or health care proxy (Haynor, 1998). Advanced directives that are available are often out-dated, ambiguous, incomplete, unacknowledged, or disregarded by both healthcare providers and family members. An educational program was offered to the residents of a low-income senior housing complex to introduce the Five Wishes advanced directive developed by the Commission on Aging with Dignity. The program involved informing the participants about advanced directives, identifying communication strategies for the participants when talking with their physician and family about their wishes, encouraging and assisting participants to complete an advanced directive, and identifying ways to distribute their completed directive. The program was attended voluntarily by thirty-two residents. Results of the anonymous program evaluations revealed the program provided good information about advanced directives, that the information was useful, and that the participants felt more knowledgeable about advanced planning. The majority of participants stated they felt comfortable discussing their wishes with their physician and family, and most wished to complete an advanced directive. Nurse practitioners are in a unique position to provide education, support, and guidance for patients regarding advanced directives. Advanced care planning should be an integral part of the patient\u27s health care. The longitudinal relationships formed through continued health care provision give primary care practitioners the opportunity to help patients remain in control of their care throughout their lives and to keep the patients informed of changes in self-determined healthcare laws and health policies