Despite the benefits of advance directives, they are frequently not completed due to lack of patient awareness/understanding of them or because of the discomfort of providers in discussing end-of-life care (Woollen & Bakken, 2016). This discomfort may be due to providers' lack of necessary training, not realizing that advance directives are not just for those who are terminally ill, fear of creating patient/caregiver anxiety, or not being reimbursed, or having time to discuss advance directives (Woollen & Bakken). Both patients and clinicians wait for the other party to bring the topic up, leaving this important subject largely undiscussed (Woollen & Bakken). It is important for home healthcare clinicians to initiate a conversation regarding advance directives. Some of the most important end-of-life goals to be addressed during the process of drafting the advance directives are: pain and symptom management, preparation for death, achieving a sense of completion, deciding on treatment preferences, and being treated as a whole person (Benson & Aldrich, 2012).
An advance directive is a general term used to describe living wills and medical powers of attorney (also known as a surrogate/proxy or durable power of attorney) (American Geriatrics Society [AGS], 2015). Living wills help to ensure the patient's wishes are followed regarding using, withholding, or withdrawing life-sustaining treatment when the patient no longer has the ability to make their own decisions (Benson & Aldrich, 2012). Patients and clinicians can visit the National Hospice and Palliative Care Organization Web site at www.nhpco.org to obtain the necessary forms to document a living will (AGS, 2015). Although patients do not need lawyers to create an advance directive, they are welcome to utilize one (AGS, 2015).
The medical power of attorney is a person of the patient's choosing who is designated to make healthcare decisions for the patient when they are no longer able to do so on their own (Benson & Aldrich, 2012). Although the living will states the types of treatments a patient does or does not want, the durable power of attorney will have the ability to make decisions beyond the document. Thus, the living will serves as a basic guide for the medical power of attorney to ensure they are honoring the patient's wishes regarding their healthcare (Benson & Aldrich). The goals of a medical power of attorney are to help the person think about planning for future medical decisions; learn the values and goals of the person; and discuss the values of the patient and general treatment preferences with caregivers and providers (AGS, 2016).
A patient can identify a medical power of attorney by writing the name in a living will, or by completing a Durable Power of Attorney for Health Care form that assigns a proxy, which is recognized in all states (AGS, 2016).