While doing rotations last year, three students at Marian University College of Osteopathic Medicine noticed something: Many patients who could no longer make decisions about their end-of-life care had not prepared advance care directives (ACDs) to guide relatives and physicians in making those decisions for them. This increased stress for everyone at an already stressful time.

The students thought that a quick, annual conversation with a physician or medical staff member would remind active patients of the importance of having an ACD, MU-COM student Dylan Kelleher said. He and his classmates took action: At last year’s ISMA convention, they introduced Resolution 18-50: Supporting Yearly Discussions of Advance Care Directives With Patients, which the 2018 House of Delegates adopted.

“We recognized how difficult a conversation it can be for both the provider and the patient,” Kelleher said.

“But we felt as though taking a quick moment to discuss it with patients would reduce unnecessary medical treatment, limit end-of-life care spending, and limit the family’s and providers’ uncertainty of how to best proceed in accordance with a patient’s wishes in situations where care may need to be withdrawn.”

The resolution includes support for educating physicians at all stages of training about advance care directives. The following resources, compiled by ISMA staff, can help in discussing end-of-life care options with patients.

AMA policy:
Code of Medical Ethics – Opinion 5.1 (Advance Care Planning)
This guidance deals with how physicians should routinely engage patients in advance care planning in keeping with Code of Ethics guidelines, which are listed at www.ismanet.org/Opinion5-1.

AMA Code of Medical Ethics Opinions on Caring for Patients at the End of Life
This is available as a downloadable PDF document: www.ismanet.org/AMAendoflife5

Other resources:
Informed Consent and Decision Making This AMA online course helps physicians identify the standard process of informed consent and how to handle situations when patients cannot give informed consent. Free for AMA members; $20 for nonmembers. www.ismanet.org/AMAinformedconsent

End of Life Care: Facilitating Early Discussions with Patients
This is an AMA and Stanford Medicine Steps-Forward online course for physicians. (www.ismanet.org/endoflifediscussions)

The Conversation Project
This initiative of the Institute for Healthcare Improvement helps physicians and others discuss end-of-life topics. Topics include how to engage patients and families about end-of-life care, resources and research on end-of-life conversations. www.ismanet.org/ConversationProject

Ethics Talk podcast
This AMA Journal of Medical Ethics podcast includes episodes on “Healthy Dying and How It Can Happen” (www.ismanet.org/HealthyDying) and “Facilitating End-of-Life Care Discussions through the Conversation Project.” (www.ismanet.org/FacilitatingEndOfLife)

CaringInfo
This National Hospice and Palliative Care Organization website lists many resources, including state-by-state documents. (www.ismanet.org/PatientsCaregivers).

It also has free, downloadable advance directives and forms for Indiana and other states. Indiana law provides for a Physician Orders for Scope of Treatment (POST) form, which includes information in addition to a standard do-not-resuscitate order.

The Talk Seniors Need to Have With Doctors Before Surgery
This article in Kaiser Health News contains information about the American College of Surgeons’ new Geriatric Surgery Verification Program. It also lists five questions that surgeons should use to guide discussions with older patients that require complex decision-making. (www.ismanet.org/GeriatricSurgery)