For Clients Making Critical Medical Decisions: Use a Checklist!

I’m always on the lookout for helpful tools related to advance care planning. Here’s one to help clients and their doctors communicate better – so that your clients can make the best decisions about their care at critical times.

National Healthcare Decisions Day (NHDD) is coming soon – April 16. You may want to share this with clients as an NHDD message.
“ABCDE” Advance Care Planning Checklists

The goal of these two checklists is to ensure that the patient, family and the care team are all clear about the patient’s prognosis and the patient’s preferences of care before making important decisions. When critical decisions need to be made, use the Family checklist below. If you’re not sure you’re at a critical point, ask!

Family ABCDE Checklist

Announce to the medical team that you have an advance directive (e.g., a living will, DNR, health care power of attorney)

Be clear with the medical team about your intentions for treatment in the face of executing the advance directive

Communicate and Coordinate with family Members to ensure everyone understands the treatment plan

Discuss next steps

Explore the benefits of palliative and/or hospice care
The Care Team checklist below is the expert recommendation for how doctors and hospital teams should talk with you and your family in critical medical situations. If the doctor has not done the things below – or has not done them sufficiently for you to understand — ask your doctor for this information before making any critical decisions about care.

Care Team ABCDE Checklist

Ask patients or caregivers about the intention of the advance directive

Be clear about the patient’s condition— differentiating terminal, non-treatable conditions from critical, treatable ones

Communicate clearly with patients and care team Members if you feel a patient’s condition is reversible and/or treatable

Discuss next steps with patients or caregivers using an action plan to determine how to respond to a patient’s wishes under critical conditions

Explain to all involved in a patient’s care—from family Members to the care team—that it is okay to withhold or withdraw certain care if it correlates with the patient’s perceived wishes. This can set the stage for discussions around hospice or palliative care.

These two ABDCE checklists were developed by Dr. Ferdinando Mirarchi, medical director of the Emergency Department at the University of Pittsburgh Medical Center – Hamot, and a national research expert in the actual use of advance directives in medical settings. The checklist concept, introduced to medicine to improve the quality of care, was pioneered by Dr. Atul Gawande, the author of The Checklist Manifesto and, most recently, Being Mortal, his reflection on how physicians and modern medicine can improve the process of dying as well as living.

Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.

Academy Guest Blogger
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