Advance Directive
Houston Hospice Virtual Tour
Established in 1980 as a 501(c)(3) nonprofit organization, Houston Hospice’s mission is to provide uncompromising, compassionate, end-of-life care to patients and families in our community. Join us in the Houston Hospice Virtual Tour.
As a member of the prestigious Texas Medical Center, we work closely with doctors, hospitals, and assisted living facilities to provide a holistic approach to hospice care. We are proud to say that we care for the whole patient and their families across 10 Texas counties. In addition to our specialized approach, you will have opportunities to be with your loved one when they truly need you the most. Take a virtual tour of our facility, located at 1905 Holcombe Blvd., Houston, Texas 77030. Here, you will see our private rooms, serene chapel, and The Garden at Houston Hospice, maintained by The Garden Club of Houston. We also provide care for patients at home or their facility of choice. To find out more, give us a call 24/7 at 713-468-2441 , or visit our website at www.houstonhospice.org.
About Houston Hospice
Houston Hospice is a 501(c)(3) nonprofit organization that provides compassionate, end-of-life care to all patients and families across 10 counties in the Greater Houston Area. Established in 1980, we are the oldest, largest, independent, nonprofit hospice in Houston and a member of the Texas Medical Center.
Arrangements to Make When You or a Loved One Has Terminal Illness
If you or a loved one has been diagnosed with a terminal illness, you are likely to be flooded with emotion and may be unsure of the next step to take. It’s overwhelming to receive such life-changing news. Take the time you need to digest and process this information, then begin to prepare for the next steps. There are practical arrangements that need to be made to help make the coming days easier. Let’s discuss a few important arrangements to take care of that can benefit not only you but also your surviving loved ones.
Determine Plan of Care
When you have received the terminal diagnosis, one area to consider is your plan of care. First, talk to your doctor regarding available treatments and whether they are in your best interest. They may not save your life, but they may extend it. You also want to consider whether you would like to receive palliative care. According to Verywell Health, palliative care can begin at diagnosis, unlike hospice, and will help improve your quality of life and ease your symptoms. Patients receiving palliative care often live longer, experiencing relief from ailments and discomforts. Research which company you would like to receive care from and discuss the anticipated timeline of care with your doctor and loved ones.
Read the rest of this entry »
Advanced, palliative care plans important part of life
Published in Cleveland Jewish News by Becky Raspe
It’s best to be prepared in every situation, especially when it’s health-related.
According to Rabbi Akiva Feinstein, director of spiritual care at Montefiore in Beachwood, and Dr. Beth McLaughlin, chief medical officer at Hospice of the Western Reserve in Cleveland, creating a plan for advanced and palliative care makes decisions easier.
How to Plan, Prepare, and Realistically Pay for Long-Term Care
Published in caringfromafar.com
When you plan for your future, do you include any plans for long-term care? It’s an aspect of life that too many adults fail to properly plan for, and that can leave seniors and family members struggling to find a solution. So, if you really want to prepare beforehand, you need to make some smart plans to cope with and pay for long-term care.
Focus on Your Long-Term Care Strategy First
Use Medicare to Your Advantage
Before you begin setting aside funds for long-term care, it’s important to have a good idea of what that situation may look like for you or a loved one. For many older adults, this means taking a look at how Medicare will offset any long-term care needs. While Medicare and Medicaid offer little long-term care assistance, the former can offer peace of mind through Medicare Advantage plans. These supplemental plans cover more of your future care, but it’s important to know the enrollment dates so you don’t miss out on this opportunity.
Know What Factors Put You at Risk
Another smart way to plan for long-term care is to examine your family history and lifestyle choices. For example, seniors with Alzheimer’s are likely to need progressive long-term care, and this is a condition which tends to be passed on from one generation to the next. But knowing you have a risk of developing dementia or Alzheimer’s also allows you to make changes in your life to potentially halt the impact of these illnesses. You can exercise more, change your diet, and even use puzzles and games to help decrease your need for long-term care in the near future. Cognitive decline is a major risk factor for long-term care, but serious falls can be a culprit as well. Also, dedicate some time to making your home a safe spot to age in place.
Put Together Your Plan to Pay for Care
Photo by Pixabay
Assess Your Insurance Coverage Options
You know that Medicare Advantage plans can help seniors stay better prepared for the future, but do you know how Medicare or health insurance covers long-term care costs? This may be a shock, but Medicare and Medicaid offer minimal long-term care coverage. In fact, the only aspects most health insurance plans will pay for are actions directly related to your health. So, the more routine care that most long-term care seniors need likely won’t be included in your average healthcare coverage. For many seniors, this is where options like long-term care insurance come in handy. If you plan ahead, this supplemental coverage is not as expensive and can offset some of the financial burdens. Understanding this kind of coverage can be a challenge, so make sure you carefully read through and research policies before you commit.
Research Other Viable Ways to Pay for Care
Medicare may not help, and long-term care insurance is not the perfect option for everyone. So, how can seniors find other ways to make sure they get the long-term help needed? Thankfully, there are some smart solutions to help give seniors and their families financial peace of mind. If you have served in the military, you may be eligible for more comprehensive VA coverage for your future care needs. It’s a benefit many veterans and loved ones forget, but this assistance is priceless for those struggling to find ways to afford long-term care. For adults who are not veterans, there may still be tools to help with costs. Financial assistance is available for seniors and family caregivers, but you can also reduce the expenses of care by carefully researching facilities and care providers. In essence, you can cut down your expenses by planning ahead.
Long-term care doesn’t have to be stressful, expensive, or, most importantly, an afterthought. It’s an essential step most adults will likely face at some point in the future. So, you should plan for long-term care just like you do any other important aspect of life and give yourself and your family some needed peace of mind in the process.
Suggestions for adult children caring for aging parents
Published in OA Online By Raylene Weaver, LPC of Centers for Children and Families
The Beatles will always be one of my favorite groups. One of their songs that has hit home with me while thinking about this particular article is, “When I’m Sixty-four”.
People want to be needed and appreciated especially when approaching a time in life when it’s easy to be disregarded or forgotten. The aging process can be stressful, causing some to suffer anxiousness and sadness. Several of my clients and friends have faced or are facing tough decisions that are affecting their parents and themselves. I would like to pass on a few suggestions regarding the physical, emotional, mental and financial aspects of AGING that might alleviate some of the stress that can definitely arise for all concerned.
A…ASK parents specific questions concerning their health. Do family members know their medical history, names of their doctors, any medications they might be taking or appointments they are scheduled on a regular basis? If on Medicaid or Medicare, do they also carry supplemental insurance? Are all financial papers, investments, bank account information, bill payment procedures, updated will, computer passwords and any other important documents or information easily accessible? Do they have a bereavement plan?
G…GUILTY feelings about wanting to be prepared by creating a plan for a parent’s future? Questions concerning the private aspects of their lives might seem like prying but this can hopefully be of some consolation for parents, knowing that they will be taken care of “when the time comes”. The objective for the children is to be “in the know” not to be “nosey”.
I…INDEPENDENT lifestyle is what one wants for aging parents. Parents hope to be independent for as long as possible. They want to continue to travel, take care of their own bills, shop, visit friends and attend worship services. Children sometimes become too “helpful” when parents are capable of handling chores and projects and making decisions for their future. Parents do need family members visiting and checking in on them, showing care and concern, just not insisting on control.
N…NECESSARY intervention will be inevitable for many parents. Knowing when to step in and offer the appropriate type of care and assistance can be stressful. Emotions will surface that might not have been seen or experienced before. When going thru matters for instance, pertaining to insisting a parent not drive any longer, taking over their physical and financial aspects of daily life or ultimately moving them into a facility for mental or physical issues or children becoming caretakers of parents in their own homes, professional agencies might be considered. Seeking assistance from those in the medical field, state/local agencies and counseling professionals might become necessary. But until this time arises…
G…GIVE the gift of respect, love and kindness to parents. They are experiencing and living life to the best of their abilities like their children. One article I came across by Evan H Farr, “What Aging Parents Really Want from Their Adult Children”, stated that adult children should: 1) make suggestions instead of giving orders, 2) pick your battles about what parents can and cannot do, 3) reframe, don’t blame and 4) stop and think how you would want to be treated.
So I guess that brings me back to the Beatles. A couple of the lines from Paul and John’s song says, “Will you still need me, will you still feed, me when I’m sixty-four?” Can I just ask…when I’m 74, 84, 94?
Advance directives: How to talk with patients about them
Published in AMA Wire
A patient’s comfort in contemplating, completing or even discussing an advance directive can greatly depend on what the physician has to say and offer.
It is often an awkward situation, in large part because many patients only see the advance-directives process in terms of suffering and death. That does not have to be the case.
“When physicians approach advance-care planning from the aspect of living well and quality of life, then patients feel reassured and then they want to engage with you and tell you what matters most,” according to internist VJ Periyakoil, MD, director of palliative care education and training at Stanford University School of Medicine.
Dr. Periyakoil wrote the “Planning for End-of-Life Decisions with Your Patients,” online physician education module.
The module is part of the AMA STEPS Forward™ collection of more than 50 practice-improvement education modules. It is part of the AMA’s strong support of advance directives and the help it provides to physicians on end-of-life matters, including guidance from the AMA Code of Medical Ethics.
Medicare also has helped spur interest in advance directives, with payment starting in 2016 for every patient to have a voluntary consultation on the matter with a physician or qualified health care professional. This benefit has been widely used, with about 14,000 providers billing almost $35 million in the first year.
A recent review of 150 studies of advance directives found more than a third of Americans have them, in some form or another. That leaves a large majority—many with the most immediate need for advance directives—without written instructions that will protect their intentions or provide for trusted family or friends to make care decisions if they are unable.
A focus on what matters most
The CME credit-eligible module from the AMA is based on the Stanford University Department of Medicine’s Letter Project. The module’s central, downloadable element is a three-page letter template that in plain language guides the patient through expressing life values and goals, as well as care instructions such as palliative sedation.
The letter template is available in eight languages and written at a fifth-grade reading level. Patients can complete the letter by themselves or be aided by patient navigators or other clinicians. At Stanford, completed letters are scanned into the patient’s electronic medical record using a barcode.
Though not a formal advance directive or living will—those are governed on a state-by-state basis—the letter can be used as a worksheet to help patients express their wishes in simple language. A physician can include the letter in a patient’s medical record as patient-generated health data.
The module provides detailed advice about how to initiate the conversation. Dr. Periyakoil said her approach is to “normalize” the process by saying, “I ask this of all my patients.”
In that way, “patients don’t feel that they are singled out for this.” Her goal, she assures them, is “to provide you with the best possible care and to do that it really helps me to understand what matters most to you.”
The letter provides check boxes for standard end-of-life care questions and space for naming the individuals who can make medical decisions if the patient is unable, but starts and devotes most of its space for patient to write about what’s most important to in terms of what’s important in life:
- What matters most to me (examples: being at home, going to church, playing with my grandchildren).
- My important future life milestones (examples: my 30th wedding anniversary, my grandson’s graduation, birth of my granddaughter).
- This is how we prefer to handle bad news in my family (examples: we talk openly, we shield the children, we do not like to talk about it).
- This is how we make medical decisions in our family (examples: I make the decision myself, my entire family has to agree on major decisions, my daughter who is a nurse makes the decisions).
- Other information about my values or end-of-life wishes I want you to know about.
“The physician can then move in confidence with clinical care that is in sync at all times with what the patient wants. Physicians often give medical advice or make care plans in a vacuum, “and we know very little about the patient as a person,” said Dr. Periyakoil.
“It is incredibly important to know everything there is to know about the disease,” she added. “It is equally important to know about the patient’s life goals and values, so that the care we provide is guided by what matters most to the patient. .”
AMA’s STEPS Forward is an open-access platform featuring more than 50 modules that offer actionable, expert-driven strategies and insights supported by practical resources and tools.
Based on best practices from the field, STEPS Forward modules empower practices to identify areas or opportunities for improvement, set meaningful and achievable goals, and implement transformative changes designed to increase operational efficiencies, elevate clinical team engagement, and improve patient care.
Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.
The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.
Tara Graham: When the unexpected happens, what’s your plan?
Editor’s note: This commentary is by Tara Graham, MSW, LICSW, LNHA, who is executive director of the Hospice and Palliative Care Program of the VNA of Chittenden and Grand Isle Counties, Vermont’s oldest and largest non-profit home health and hospice agency.
It’s National Healthcare Decisions Week. Who’s Your Person? What’s Your Plan?
It’s a simple yet vitally important question all Vermonters over 18 should be able to answer. If you are unable to speak for yourself due to incapacitating illness or injury, who will speak for you? Who will ensure the treatment you receive – or decline – reflects your beliefs and preferences?
In my work as Executive Director of the Hospice and Palliative Care Program at the VNA of Chittenden and Grand Isle Counties, I engage with individuals and families facing life-limiting illness every day. Conversations about wishes, values and preferences at the end of life are a necessary part of the hospice philosophy of care. These conversations can be at once routine and profound. The process of dying is a daily part of my life and I realize that this is not true for most people – it isn’t even consistent among those closest to me personally.
For many, talking about debilitating illness or injury and death is completely foreign and something to be avoided. It’s uncomfortable, some may even say a little morbid. But here’s the thing: I believe it is a person’s innate right to choose the direction of their lives until the moment he or she dies, regardless of their ability to communicate their needs. We all hope to never have a serious car accident, but we purchase car insurance so we are prepared should the unexpected happen. Advance care planning – making your healthcare wishes known – is like an insurance policy against unwanted medical treatment and interventions during times of tremendous stress and uncertainty.
Despite recent gains in public awareness of the need for advance care planning, studies indicate the majority of Vermonters, and in fact most Americans, have not exercised their right to make decisions about their healthcare in the event they cannot speak for themselves. By normalizing conversations around advance care planning, and making our wishes known to loved ones and our healthcare providers, we can all be better prepared to deal with the unexpected.
I have had the privilege of hearing about people’s fears throughout my career as a social worker. Over and over again, the theme of losing capacity or loss of control is consistently at the top. Even my dad, when faced with a terminal diagnosis of glioblastoma, who knew intuitively when he no longer wanted to pursue curative treatment, so he could focus instead on quality of life for his remaining days, found himself having to explain his decision to family and friends. My dad was able to make his wishes known. Thankfully, he also had an advance directive in place in the event he became unable to speak for himself and my mother and sisters needed to make healthcare decisions for him. He gave us the gift of certainty.
Imagine if we could chart a path, lay out scenarios and share with those that love us about how to represent us at a time when we might not be able to represent ourselves? This is a very real, obtainable possibility.
Advance Care Planning: Reminder for YOU to Have the Conversation
By Cozzie M. King, National Coalition for Hospice and Palliative Care
The scenario generally plays out the same. A person becomes ill…too ill to make decisions for themselves…too ill to communicate with the attending medical staff. Nearby family rush to the hospital bedside. The physician explains what’s happening to the family. Things aren’t looking good or the medical terminology is not easy to understand. After some time, the family is left to make decisions for their seriously ill loved one. Decisions that have not been discussed or thought about prior to this point. What do we do? Who has the final say? Things normally go downhill from here. You’ve seen it. I’ve seen it. Medical staff dread it. No one wins. Making healthcare decision at the hospital bedside is not the right time. These conversations need to happen before the crisis, not during.
Speak Up
As a mom, sister, daughter, past and future caregiver, I understand the importance of having conversations about my future healthcare decisions with my family and friends. These conversations can be hard to begin. However, there are many resources, tools and games that help families have these talks in creative ways. Over the years, I have facilitated several talks on how to plan and communicate your future healthcare decisions. One of my personal favorite resources is the Speak Up video. This video is one of the tools I consistently use when explaining why it’s so important to have the conversation and complete an advance directive. I encourage you to post and share this video with your family and friends on Facebook. They’ll thank you later. The message is short and simple. Check it out:
Click to watch NHDD Speak Up Video
As we advocate for more families to participate in advance care planning, keep it simple. I remind my family and friends that advance care planning is much more than completing a form. It really is more about the conversations you have before and after any document is completed.
Lead By Example
April 16th is National Health Care Decisions Day (NHDD) and this year’s theme is, “It always seems too early, until it’s too late.” NHDD is a call to action for EVERYONE to:
→Think about your beliefs and values,
→Write them down,
→Choose a healthcare proxy (someone who speaks for you if you are not able),
→Complete an advance directive, and
→Share with your healthcare proxy, family and doctors.
The purpose of NHDD is to inspire, educate and empower the public and providers about the importance of advance care planning – and most importantly, to encourage people to express their wishes regarding healthcare and for providers and health care organizations to respect those wishes, whatever they may be. As someone in the health care field, be sure to complete your advance directive and encourage your colleagues and loved ones to do the same. Practice what you preach. Read related story in TMC News
The Other Side of the Conversation
Author: Christopher M. Thompson, MD, HMDC
This article originally was published in Winter 2017 NewsLine.
In this post, a physician connects his personal and professional caregiver roles.
As palliative care providers, we spend our careers talking about end-of-life care and helping families make difficult choices about life and death. Have you ever been on the other side of the conversation, answering questions and making decisions for your own loved ones? I have cared for thousands of patients at the end of life, but recently I’ve been on the other side of that conversation – twice.
My first conversation began with “Momma,” my wife’s 91-year-old paternal grandmother. Her decline started with a kidney stone, which then led to urinary tract infections and tremendous pain. Momma made the decision to have lithotripsy. During the procedure, she had respiratory distress and required intubation. Her heart was not strong enough to tolerate this “routine” procedure. She developed right-sided heart failure and pulmonary edema. Doctors were able to extubate her; however, she continued to have more respiratory distress. She was not doing well. They placed her on Bi-pap but she did not tolerate this. She was in the hospital, agitated, dyspneic, and did not want to be re-intubated.
So now what? Our family had to begin those difficult discussions. Do we continue to push aggressive care? Momma told the family she was tired and ready to die. It was hard for our family to acknowledge what this meant even knowing her wishes. Added to that, it was two weeks before Christmas and my family lived six hours away from Momma. We decided my wife and our three-year-old daughter would travel to Georgia while I stayed home to work. I wanted my wife to be there for the conversation in person and to see her grandmother, as I knew this might be her final days on earth. After discussing options, the family agreed to inpatient hospice care.
I was too involved with work and like many times before chose work over family. My wife was at Momma’s bedside for less than 24 hours when she called me telling me that Momma was asking for me, “The Doctor.” I pulled myself away from work in the middle of the day and headed to Georgia.
I was now being asked medical questions as well as “what about Christmas?”, “what do we tell the great-grandchildren?”, and “is this the right thing to do?” I did not have answers. I had memories and emotions for this woman I loved; I did not want to think, “Momma is dying.”
All the signs were there; it was her time to die. The family began the journey with Momma. I have worked in three different inpatient hospice facilities. It’s easier for me to study the staff, their workflow, their EMR, their census, their medical director – this is what I know. My wife reminded me that this time, I was there for Momma and our family. I was not “The Doctor” now; I was family.
Staff managed Momma’s symptoms quickly and she had two good days talking and interacting. We had made the right choice, albeit not an easy one. Long days and nights at the hospice home wear a family down. Hospice staff participate in these experiences daily. We think how hard it must be for the patients and families. When you are on the other side, you feel the sorrow and you learn a lot about the value of hospice care.
Momma died peacefully four days later. We returned home to North Carolina, only to receive a phone call that “Granny” was in the hospital. Granny was my wife’s 78-year-old maternal grandmother. She had Alzheimer’s disease, had fallen at home, and had developed altered mental status. She was not eating, she had a UTI, and a CT scan showed a small hemorrhage in the frontal lobe. Granny was agitated, not eating, and declining. So now what?
Just three weeks earlier we had lost Momma. Now our family was deciding on inpatient hospice for Granny.
My wife, daughter, and I packed the car and headed for Florida. I took the time from work, but I was still on call and was on the phone, giving orders the entire trip. Once again, it was easier for me to do my work as a hospice physician than confront what I had no control over. We were losing both our grandmothers within three weeks.
As we arrived in the middle of the night, we received a call letting us know Granny died. She had declined quickly. That was truly a blessing. After all the heartbreak and tears, we went to Granny’s house and celebrated her life. This is what she would have wanted.
Those two experiences remind me how hard end-of-life conversations are for families. We as palliative care providers need to remember it is different when there are memories and emotions involved. No matter how informed our families are, these decisions are not easy. And, it’s hard being on the other side. We are no longer medical professionals, we are family. All our medical training leaves our mind and we become an emotional basket case. We find it hard to think straight or make rational decisions. It’s difficult living with the decisions and through those choices.
I’m 40 years old, my parents are approaching retirement, and my grandparents are dying. I have friends who are struggling with acute and chronic illnesses. All of this has made me a better hospice and palliative care physician and I’m glad I can reflect on my training and life experiences to help my patients and families. I make the conversations personal and emotional. I have more empathy during family meetings. I think this adds a new dimension to the work I do, the work I’m proud to do.
These two experiences brought our family closer together and I’m grateful I could help in the decision-making process. My family saw firsthand how our jobs as hospice and palliative care providers are intensely emotional. We all need to realize the impact we have on the families we care for, how a well-trained hospice and palliative care staff can have an impact on a family.
During our trip home from Florida, my wife looked at me and asked, “How do you do this day after day? I am proud of you and now understand your job even more and how rewarding it must be.”
———–
Christopher M. Thompson, MD, HMDC, assisted in developing the palliative medicine programs at two hospitals prior to joining Transitions LifeCare as Medical Director for Transitions Kids, Transitions LifeCare’s pediatric hospice program. Dr. Thompson is board certified in Family Medicine. After completing his Fellowship, Dr. Thompson became board certified in Hospice and Palliative Medicine with the added qualification of Hospice Medical Director Certification.
Study Encourages Having a Bucket List Talk
Talking to Doctors About Your Bucket List Could Help Advance Care Planning
February 8, 2018 by Stanford University Medical Center
For physicians, asking patients about their bucket lists, or whether they have one, can encourage discussion about making their medical care fit their life plans, according to a study by researchers at the Stanford University School of Medicine.
A bucket list is a list of things you’d like to do before you die, like visiting Paris or running a marathon. It’s a chance to think about the future and put lifelong dreams or long-term goals down on a piece of paper.
For doctors, knowing their patients‘ bucket lists is a great way to provide personalized care and get them to adopt healthy behaviors, said VJ Periyakoil, MD, clinical associate professor of medicine, who said she that she routinely asks her patients if they have a bucket list.
“Telling a patient not to eat sugar because it’s bad for them doesn’t work nearly as well as saying, for example, if you are careful now, you will be able to splurge on a slice of wedding cake in a few months when your son gets married,” Periyakoil said.
The study will be published Feb. 8 in the Journal of Palliative Medicine. Periyakoil, an expert in geriatrics and palliative care, is lead author.
The researchers, who surveyed 3,056 participants across the United States, found that by far the majority of respondents—91 percent—had made a bucket list. Survey results also showed that respondents who reported that faith and spirituality were important to them were more likely to have made a bucket list. The older the respondents were, the more likely they were to have a bucket list, and, not surprisingly, those younger than 26 tended to include more “crazy things” on their lists, such as skydiving.
Bucket list categories
Six general themes tended to describe the items on respondents’ bucket lists: 79 percent included travel; 78 percent included accomplishing a personal goal, such as running a marathon; 51 percent included achieving a life milestone, such as a 50th wedding anniversary; 16.7 percent included spending quality time with friends and family; 24 percent included achieving financial stability; and 15 percent included a daring activity.
“When you just Google the term ‘bucket list,’ it’s huge how much interest there is in this,” Periyakoil said. “It provides a very nice framework for thinking about your life goals, health and your mortality.”
Past research has found that when doctors talk to patients—especially those with chronic or terminal illnesses—about the patients’ goals for future care, it can be a vital part of the advance-care planning process. But it’s often awkward to have these conversations, particularly when they are about the end of life, the study said.
“If a patient wants to attend a beloved grandchild’s wedding or travel to a favored destination, treatments that could potentially prevent her from doing so should not be instituted without ensuring her understanding of the life impact of such treatments,” the study said.
Discussing a patient’s bucket list is just a good way to start these conversations, Periyakoil said. Most people are far more open to talking about their life’s goals in this context before filling out an advance directive, a written statement of a person’s wishes regarding medical treatment at the end of life, Periyakoil said.
‘Find out what actually motivates them’
“It’s important for physicians to talk to patients and find out what actually motivates them,” she said. She encourages both doctors and patients to bring up the topic of a bucket list. By discussing how a treatment or surgery might affect the patient’s life, and then discussing what the patient’s goals are, the best possible care plan can be laid out, she said.
“I had a patient with gall bladder cancer,” Periyakoil said. “He was really stressed because he wanted to take his family to Hawaii but had treatment scheduled. He didn’t know he could postpone his treatment by two weeks. When doctors make recommendations, patients often take it as gospel.”
After an informed discussion about his options and the side effects of the cancer treatments, he and his physician decided to postpone the treatment. He made the trip to Hawaii with his family, then returned to start cancer treatments, the study said.
“Patients don’t see the relevance of an advance directive,” said Periyakoil. “They do see the relevance of a bucket list as a way to help them plan ahead for what matters most in their lives.”
Explore further: Most physicians would forgo aggressive treatment for themselves at the end of life
More information: Vyjeyanthi S. Periyakoil et al, Common Items on a Bucket List, Journal of Palliative Medicine (2018). DOI: 10.1089/jpm.2017.0512
Journal reference: Journal of Palliative Medicine