How to Talk with Patients About Health Care Power of Attorney Decisions

Armando Hinojosa, MD – CareAllies contributor

Conversations with patients about who could make medical decisions for them - in the event they are unable to speak for themselves - can be delicate. However, it is a critical need for patients regardless of where they are in their health care journey. By encouraging your patients to think about it now, they can do so with a clear head and with time to devote to important questions. With a little forethought and planning, these interactions can build trust while ensuring patients are prepared for the unexpected. Following are a few ways to engage constructively and compassionately.

Set the stage. While it’s important that patients, especially older adults, think through a health care power of attorney (HCPA) decision, you don’t want to scare them. Emphasize that this is a proactive conversation, so they can be prepared should a situation arise where an HCPA is necessary.

Allow sufficient time for talking to the patient. The idea of an HCPA can be disconcerting, so be sure to allocate enough time for patients to process the information and ask questions. Rushed conversations can cause confusion and undue stress, which may lead patients to avoid or put off the decision.

Focus on more than end-of-life scenarios. Patients may not be aware of the diverse situations where they might need an HCPA. Consider mentioning examples that include temporary incidents, as well as permanent ones.

Talk about what happens if there is no power of attorney in place. Patients should know how your organization would handle cases where there is no HCPA documentation on record. Some states have decision-making laws that designate who should be consulted. This may include a spouse, parents or adult children.

Discuss what to look for in a health care power of attorney. Since this person may be charged with making life-and-death choices on the patient’s behalf, the patient should have full trust in the individual. The person tapped to be the power of attorney must also feel comfortable making these types of decisions and respecting the patient’s wishes, even if those wishes differ from their own. Encourage patients to think carefully about who they choose, so they select someone who will best represent their interests if the situation should ever arise.

Explain how patients can take the next step. There are many ways to complete HCPA documentation. Although consulting a lawyer can be helpful, patients can complete a form without legal counsel. State-specific forms are available from a variety of resources, including the National Hospice and Palliative Care Organization, your state hospice organization, public health departments, your local hospital, state bar associations and state aging offices.

Remind patients to use the forms specially created for your state because each state has different rules and regulations, and you want to ensure that the power of attorney will comply with your state’s requirements. Patients may need to have a witness signature and get the forms notarized, depending on the state.  

Encourage patients to share HCPA information with others. Patients should keep their HCPA documentation in an easily accessible place. In addition, they should share the information with the person serving in this role, as well as other loved ones. Everyone involved with the patient should know who the HCPA is and what the patient is asking them to do.

Consider asking patients to share HCPA information with your organization as well, so there won’t be any confusion if critical decisions need to be made. You also may want to suggest that patients tuck a note in their wallet that indicates the HCPA’s name and contact information, as well as that of the patient’s lawyer if they have one.

Provide written information, if possible. In addition to talking with patients, it is helpful to share written information about the process along with useful resources. Not only can this serve as a reminder of what you’ve discussed, but the patient can share the information with their loved ones and use it to guide conversations as they make decisions.

Keep the lines of communication open. Creating a power of attorney can introduce complex feelings and situations for patients. Remain available to answer any questions they might have and point them to appropriate resources to take the next step.

Armando Hinojosa, MD is an Internal Medicine specialist at SeniorMed in Laredo, TX and serves on the Board of Valley Organized Physicians. Dr. Hinojosa graduated from the Southern Illinois University School of Medicine in 1998.