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We Need to Start Talking More About Advanced Care Planning

We Need to Start Talking More About Advanced Care Planning

King Charles III’s thoughtful resumption of royal duties, months after his cancer diagnosis sheds light on a pervasive yet silent crisis—the lack of undocumented healthcare wishes. The king’s battle reveals a universal truth—the inevitability of health crisis and death, which spares no one, monarch or not. We all must confront the essential need for advanced care planning. This not only spares us but our loved ones from the turmoil of unpreparedness, ensuring our wishes are honored in times of crisis.

Advanced care planning is not just a formality. It allows us to contemplate and document our healthcare decisions in advance, providing clear and actionable directives if we cannot voice our own wishes. Such preparation is more than making prudent plans, it’s a respectful act that can alleviate the burden of uncertainty for us and our loved ones. Let’s use this moment in history for more than peeking into castle windows by taking action to ensure our healthcare choices are known, respected, and upheld—we know not the day nor the hour that we’ll need our preparedness plan.

Consider this reality: roughly 67% of patients with serious illness do not have their care preferences documented, such as who will speak on their behalf and to what extent should medical professionals give life-sustaining treatment. This oversight can result in significant loss of autonomy for patients at a most vulnerable time. Our society is grappling with unprecedented challenges in health outcomes like under or overtreatment of chronic conditions and long-term effects of a pandemic—let’s acknowledge that we don’t know what life will bring us. It’s crucial that we focus on the real and pressing issues caused by lack of advanced care planning.

Throughout my career amidst the sacred quiet of hospice care, I’ve been privy to the inner sanctum of families in crisis. These experiences reveal the broader societal issue of unspoken healthcare wishes. In my 17 years as a hospice chaplain, the most difficult moments to watch came when families torn by grief, found themselves at odds—sometimes escalating to threats of physical violence. Caregivers also struggle with complex medical decisions like discontinuing tube feedings that conflict with their religious beliefs. Such end-of-life decisions may do more harm than good both medically and emotionally. However, these burdensome choices can be guided by thorough advanced care planning, which aligns with patients’ spiritual values and relieves all parties from the heavy weight of doubt and guilt.

An overlooked aspect of advanced care planning is the empowerment it offers to individuals and communities. Dr. Michael Madison, an Interventional Neuroradiologist, witnessed the profound effects of denial and delayed planning which inspired him to found Thanacare, an advanced care planning company. His initiative is a response to our national hesitance to face our own mortality and emphasizes the importance of initiating proactive healthcare conversations. Thanacare’s mission is to build a bridge between patients, families, caregivers, and clinicians to improve advanced care planning rates across communities.

During the COVID-19 pandemic, our collective consciousness was awakened to the vulnerabilities of older adults, especially within racial and ethnic minority groups, who faced a disproportionate impact from the virus. This global health crisis opened our eyes to cultural and societal hesitations around end-of-life care and advanced care planning. To address these disparities, researchers implemented video decision aids and communication training to widen the reach of their message. Study results show that the percentage of all older adults who documented their advanced care plans after these efforts rose from 18% pre-COVID to 24% post-COVID. African American and Hispanic groups of older adults saw significant increases in documented advanced care planning by 12% and 8%, respectively. This marked uptick in advanced care planning post-pandemic shows a decisive shift in preparedness—it stresses the importance of serious dialogues that transcend social and cultural divides.

Critics could argue that juxtaposing the need to make healthcare decisions against the narrative of royal health is bad timing. However, we learn our greatest life lessons in moments of grief and tragedy. Advanced care planning offers us a voice in the unknown hour of death and sudden illness. These historical events offer a timely and powerful narrative for change.

King Charles III’s public confrontation with serious illness is a stark reminder that the inevitabilities of illness and mortality are not confined to any social stratum. Let this realization compel us to initiate advanced care planning conversations with our providers. You do not need a lawyer to document your healthcare preferences; there are many free resources to guide you. Planning in advance is more than a procedural act—it’s a crucial step that safeguards your values and provides your family with piece of mind. As we move beyond the myth of invulnerability, let us prepare for our futures with the dignity and foresight that advanced care planning affords.

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