Rationale  

Healthcare has advanced a great deal in the past 75 years. In just a few generations, we have seen the advent of antibiotics, antiseptic techniques for birth and surgery, the development of cardiopulmonary resuscitation and successful organ transplantation. An unforeseen consequence of more effective medical care and a resultant longer lifespan is the impact on how we die.

In the past, at the time of death, the family was present and death practices reflected the beliefs and culture of the community. Now, in present-day western societies, most deaths occur in a healthcare setting. Only 24 percent of Americans older than sixty-five die at home; 63 percent die in hospitals or nursing homes, sometimes tethered to machines, and often in pain (Volandes, 2016). The environment is often sterile, unfamiliar and family may or may not be present. In the most dramatic variation, the person dying is receiving intensive care and life support and often has been unresponsive or non-communicative for days or weeks in advance of their death. These settings offer little comfort to the families, as there is often no time for activities of closure such as last acts, blessings or goodbyes.

Research shows, not surprisingly, that families who experience the death of a loved one under such circumstances are more likely to experience complications or prolonged grief and regret.

Why are we now more than ever at risk for a death we would not choose: alone, institutionalized and perhaps in pain? The answer includes these interrelated things:

• Our medical care has advanced to such an extent that it is “easy” to prolong someone’s life
• The evolution of medical care has increased the complexity of end-of-life care decisions
• Many people never discuss their end-of-life care wishes, leaving others to guess what they would want

Like all of IHC CME live and virtual workshops, Advance Care Planning: Starting the Conversation provides an evidence-based and engaging educational experience for learners to learn and practice specific communication skills for immediate practice application.