Three Ways to Begin Talking About Advance Care Planning

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How to Have an Honest Conversation

Maryjo Prince-Paul, PhD, APRN, ACHPN, FPCN
Associate Professor
Nov. 22, 2016

With the holidays right around the corner, families across the country will soon be coming together. This year, in between conversations about how relieved we are to be through with the 2016 election, or whether or not the Browns will win a game this year, consider making room for what is likely an overdue conversation around end of life decisions.

Yes, that conversation. But not the way you think.

It’s normal to shy away from talking about death. For one thing, our society generally considers it too morbid for casual conversation. Second, we all like to tell ourselves we have plenty of time; that death is not inevitable.

We all like to tell ourselves we have plenty of time; that death is not inevitable

But, this is precisely the wrong way to frame these discussions. We can’t help but dread spending time thinking in terms of “end of life” care, or advance directives. Our avoidance of having the conversation means we spend more time considering which car or laundry detergent to buy than having an open and honest conversation about an issue that affects our own lives and the lives of the ones we love. It’s important that we finally normalize this conversation, in plain language.

Breaking the ice on these discussions is the hardest step. Here are a few ways to frame the conversation to keep everyone as comfortable and open as possible.

1. Planning and control

One of the easiest ways to frame the conversation is as a way to maintain control. While we don’t necessarily enjoy having to make decisions, we are comforted by planning. We run from this conversation not because we fear death itself, but because we fear the process, illness, and thinking about dying. We have the option to make the conversation empowering by thinking about it in a way that gives life meaning. A concept as simple as a bucket list can be a great start.

2. The importance of plain language

The term ‘advanced directive’ is intimidating in this context. Yet, they are only documents. We must focus on the conversation, which can only happen through plain language. Speaking in real terms, asking genuine questions, and finding the root of our values will uncover end of life preferences, without incorporating the stark “end of life” language that so often inhibits the conversation. Even a comparatively familiar term like ‘end of life decisions’ has a limiting effect when it comes to these conversations. ‘Advance care planning’ is not only less intimidating, but also more accurate.

When we talk about advance care planning within the context of what we value in life, we illuminate what matters most in our dying.

3. Gratitude

Sometimes it just takes demonstrating gratitude to open an opportunity for discussion. This is the season during which we express what we are thankful for. Let your loved ones know that you are grateful they are in your life. Grateful enough that you want to open a dialogue on these issues.

It is time for a cultural shift in how we think, talk about, and embrace advance care planning. These conversations should never be complete. Instead, they are part of a sustained, ongoing process. Our values are different at each stage of life. Our worldviews change with new life events.

Advance care planning is about starting a perpetual conversation around what we value in life. What meaningful life is to us. Our life goals. What we would consider a quality of life worth living. It is a conversation less about decisions, and more about what ultimately drives us to conclusions.

Maryjo Prince-Paul is an associate professor at Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio. Her research interests include palliative care, patient-centered communication, quality of life concerns, end-of-life care, intraprofessional education and oncology. She can be reached at