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Giving Thanks and Talking Options

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Every year, Thanksgiving tends to ignite conversations with family members and friends in a way no other Holiday can.

“So how about this election?”

“Is Michael really applying to college as a philosophy major?”

“Should we really be watching a sport that irreparably destroys the brains and bodies of young men?”

“Are Matt and Michelle getting a divorce?”


This year, make a vow to avoid family gossip and instead focus on your health, and taking care of your family and friends. Those in contact with you this time of year are likely also the ones you would turn to for advice when faced with a risky surgery or another important decision about your health care, so this can be a good time to raise some questions. What would you do if a procedure left you unable to make decisions or care for yourself? Also, what if you become responsible to care for those loved ones in the event they experience a similar situation and are unable to make their own healthcare decisions? Advance directives – legal documents in which a patient identifies an individual authorized to make decisions and provide directions for end-of-life care – are key to ensuring your wishes are met when you are otherwise unable to express them. When you’re ready to discuss those choices, those close to you need to be part of the conversation.

November is Hospice and Palliative Care Month, and we’re continuing our discussion of advance directives by highlighting Penn Medicine’s OurDirectives.org site -- a new, simple to use platform created at Penn that makes this valuable document conveniently available to patients, those they would designate to make their decisions, and their care teams.    

The our directives site allows anyone – regardless of whether or not they are a Penn Medicine patient – to create an online profile in which they can complete, update, and share an advance directive. Users may also print that advance directive to give to their decision-making loved ones and care providers.

In addition to hosting the legal form itself, the site outlines what an advance directive is, why it’s important, how to start the conversation, and other issues associated with creating the document. Browsing the site brings up questions – like whether you would choose to undergo chemotherapy for cancer, or be placed on a breathing machine – that may be overlooked until it’s too late to be a part of the decision-making process.

In addition to hosting the legal form itself, the site outlines what an advance directive is, why it’s important, how to start the conversation, and other issues associated with creating the document. Browsing the site brings up questions – like whether you would choose to undergo chemotherapy for cancer, or be placed on a breathing machine– that may be overlooked until it’s too late to be a part of the decision-making process.

“The advance directive identifies that the patient ‘had the conversation’ with family, their primary care team or others and directs those now required to speak on behalf of the patient to share those treatment goals and identify their quality of life priorities,” said Susan B. Kristiniak DHA, MSN, RN, AHN-BC, NEA-BC, associate director for Palliative Care at Penn Medicine. “The document supplies care teams the validation of that effort and then assists in first identifying who will be responsible for decisions when the patient cannot participate and a clearer understanding to align patient treatment planning with those goals.   

Recently, the Our Directives group hosted two information sessions to support patients and answer any questions they had. Eleven patients completed an advance directive during the sessions. Sessions like these have the potential to help a lot more patients, as most of them currently do not have an advance directive. A recent Philadelphia Inquirer article mention of the OurDirectives platform reports that fewer than a third of hospital patients have an advance directive available to their care team.

General practitioners can usually walk patients through any questions they may have, and insights from the Penn Medicine News Blog’s Q & A on advance directives with Mrinalini Sarkar, MBBS, a hospitalist at the Hospital of the University of Pennsylvania, may help begin the conversation – whether it’s over the holidays or in the doctor’s office. 

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Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department(s), University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

Health information is provided for educational purposes and should not be used as a source of personal medical advice.

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