How to talk to a doctor about end-of-life planning

Talking about end-of-life planning with family members requires a person to think critically about their values, quality of life, and treatment options. But in addition to family, it is important to discuss these matters with a healthcare team, especially a primary care physician (PCP). Not only will it ensure that care aligns with goals, but it will likely help a person learn about the treatment options that suit them best.

Identify who best to talk to: Which doctor within your healthcare team has the most knowledge of your current health status? Who do you have the strongest relationship with? These factors will help you decide who is the most appropriate person to talk to. This could be your primary care doctor, or a specialist if you have a chronic condition.
Schedule an appointment: When do you believe will be the best time to have this conversation, and under what circumstances? Remember that this conversation can be done virtually or in person. If you plan to have this conversation with your primary care doctor, you could discuss this at your next annual wellness visit. Medicare beneficiaries can add “advance care planning” to their annual wellness visit appointment. Note: Medicare Part B will reimburse the doctor for a 30 minute conversation to discuss advance care planning.
What to bring with you to the appointment: Perhaps you have already documented your goals, preferences, and values when you had the conversation with your family. If so, great! You can use those materials to augment your conversation with your doctor. Below are a few tips:

The Conversation Project and Compassion and Choices organizations offer comprehensive toolkits to help you prepare for and guide you during your conversation.
Bring your health care proxy: Having your health care proxy or family member present to document the conversation will be beneficial for you or your loved one.
Bring your Advance Directive: This document is to be completed by anyone 18 years or older. This document identifies an appointed power of attorney (for financial purposes) and states your medical wishes. It must be signed by you and two witnesses or a notary. Make sure to provide your doctor with a copy of your advanced directive.
Bring your doctor Orders for Life-Sustaining Treatment (POLST, by state) : This is a medical order for individuals who are seriously ill or frail. This document holds true across care settings. It must be signed by the individual or health care proxy and the doctor.

Be direct: Jump right in by identifying the intention of the conversation. Include the conversation you would like to have, the documentation, and follow up. Here are some sample statements to use:
- “I would like to share with you my goals and preferences for my end-of-life care.”
- “After our conversation, I would like these wishes and our care plan to be documented in my medical file.”
- “I would like to revisit these plans as needed, at a minimum during my annual wellness visits.”

Ask about their willingness to comply with your wishes: Some doctors may be more willing than others to honor your wishes. This is your opportunity to ensure you and your doctor are on the same page. For example, you can ask:
- “If I become terminally ill, will you educate me on the benefits and risks of treatment and end-of-life care options?”
- “Will you honor my decisions?”
- “Do you have any reservations about this request?”

Make sure you understand your doctor’s response: This is where having your health care proxy present is key. They can help you verify your understanding of the doctor’s responses. If something doesn’t seem clear, then you should ask follow-up questions. Or, have the doctor explain it in another way. For example, you can ask:
- “So, you are saying that if I become terminally ill, you will help me understand how the disease will impact my quality of life?”
- “As you know, my goal is to age at home. Will you or your care team help me identify resources to maintain my independence?”
- “Are there resources my family and I should look into and plan for now?”