As you may recall from previous years, April 16th has been declared National Healthcare Decisions Day. For those unfamiliar, this day is set aside to encourage us all to think about and document our wishes about medical treatments we would- or would not- want during a serious illness or at the end of life. It’s also a time to appoint someone else to make decisions for us should we lose the ability to make our own health care decisions. This process is known as advance care planning. While a recent poll found that 90% of us know it’s important to discuss these issues involving end-of-life treatment and care, more than ½ of us have not even started a conversation about this with our loved ones, much less documented our wishes. You might have thought that, going through the COVID pandemic, more of us would have given thought to these issues, but recent research suggests that just ⅓ of us have completed a written advance directive, which was the same percentage that existed before COVID.

Even dedicated research efforts to inform and help individuals fill out advance directives are not always successful. For example, in a recent study published in JAMA Network, almost 65,000 adults participated in a structured program providing trained facilitators, an information portal, and printed resources to educate them about advance care planning and support them in filling out advance directives, while also hoping to reduce the incidence of burdensome end-of-life care on the participants. While 12% of the participants did document new end-of-life treatment preferences (compared to only 6% of the control group), the intervention process also led to an increase in burdensome end-of-life care for a small subgroup, including feeding tubes and mechanical ventilation. Moreover, Black participants, older participants, and those with dementia all had less positive results documenting their wishes. If nothing else, this study underscores the challenges and complexities of encouraging individuals to think and document end-of-life treatment choices. On a brighter note, however, another recent study involving older adults (80+) with cognitive impairment demonstrated that individuals living with dementia could still participate in advance care planning by identifying a surrogate decision-maker and even expressing treatment preferences with sufficient support and structure.

As an agebuzz reader, you likely already know that filling out an advance directive, whether it’s a living will, health care proxy/power of attorney, or such other important documents as a POLST order, is essential to ensuring that you- and your involved loved ones- can make sure that the care your receive at the end of your life is consistent with your values and the choices you have made when you could do so. If not for yourself, then do it for those whom you love and who will be given the responsibility to make decisions for you if you are unable to do so yourself. But what about those of you who have not yet executed these important documents and may still resist, even with this encouragement? How do we get you to take the plunge and fill out an advance directive? Well, first, let’s make it easy for you to access useful resources that will make the process easy and quick. In most cases, you don’t need a lawyer, a notary, or much if any money to document your end-of-life wishes. Here are several websites that can walk you through the process and make sure you can access the forms acceptable in your state: 

• The Conversation Project, which has a range of free and downloadable guides to help you think, discuss, and execute the essential advance care planning documents.

• The Stanford Medicine Letter Project, which provides written, downloadable templates to help you spell out what your values are, what matters to you in life, and how to have these important conversations with your loved ones and your physicians.

• Prepare For Their Care, an organization housed at the University of CA SF, which has spent years researching strategies and programs to support individuals in expressing and documenting their end-of-life choices.

• Caring Info, a program from the National Alliance for Care At Home, which includes dedicated information on state-specific forms along with advice about preparing and storing your advance directive.

Or, if you’d like to dive into a valuable book that’s essentially a step-by-step guide to advance directives along with all other planning necessary to ensuring a “Good Death,” take a look at the new book by palliative care and end-of-life RN and doula Suzanne O’Brien, The Good Death: A Guide for Supporting Your Loved One through the End of Life.

As President John F. Kennedy said, “The time to repair the roof is when the sun is shining.” So, get going on your advance directives now, while you are healthy, capable, and have the ability to discuss your values and wishes with those you love and who will be there to support you through the end of your life.