Healthcare providers, including case managers, can bring up end-of-life issues with their most frail and ill patients by approaching it in a Q&A format.

For instance, Mary Mareck, MSW, a geriatric consultant and founder of Mareck Family & Geriatric Services in Lansing, MI, developed the following list of questions that can lead into a discussion of advance directives:

  • What is my diagnosis, and how does it relate to other medical conditions I have?
  • What are the treatment recommendations?
  • What are the side effects, long- and short-term?
  • Where, when, and how will the treatment take place?
  • Will treatment lead to a longer or more comfortable life?
  • What are the risks and benefits of the treatment? If it is not successful, what will be the next step?
  • Does the cost justify the outcome?
  • What if I change my mind because the side effects do not support the benefits of the treatment?
  • If we want more information before making a decision, where can we get it? Second opinion?
  • If I do not want the treatment, what will happen, how much time will I have, and what will that time be like?
  • If my goal is to die peacefully — not in a hospital, but with my family — where does this treatment fit? Does it match my goals?
  • Is hospice something to consider at this time?