Making the Most of Your Conversations About Advance Care Planning

In their session, “Advance Care Planning Conversations: Tools for Success,” Denise Nicholson BSN, RN, advance care planning program manager at Gundersen Health System in La Crosse, Wisconsin, and Colleen Nevins DNP, RN, CNE, associate professor emeritus at California State University Channel Islands in Camarillo, California, describe the best practices for advance care planning conversations and review innovative approaches for teaching nursing colleagues the essential skills to effectively communicate difficult topics with patients and their families.

The goal of Denise Nicholson’s portion of the session was to help her colleagues develop the necessary skills to address advance care planning during professional practice.

She began the session by noting that most people: (1) believe advance care planning is just a bunch of paperwork, (2) is only necessary for older individuals or those on the verge of death, and (3) assume they already have an end-of-life plan in place, known as an advance directive.

However, only one in three people have an advance directive, and so it is important to have these meaningful, but challenging conversations with patients or their family members. Denise Nicholson noted that nurses should strive to normalize the conversation around advance care planning by asking open-ended questions, opening the door to deeper conversations, as well as making it clear that there are no right or wrong answers or good or bad decisions. Nurses should be made available just to have a conversation, listen to an individual’s story, and to affirm their experiences and purposes.

Toward the end of her presentation, Denise Nicholson advised nurses who anticipate having conversations with individuals or their family members about advance care planning to explore with those individuals their past experiences, discuss what is important to them, and talk about their fears and or concerns about the process.

Following Denise Nicholson, Dr Nevins discussed “the application of innovative tools to help normalize advance care planning conversations.” Dr Nevins did this by reviewing the benefits and challenges associated with immersive tools, including the integration of virtual and mixed reality in nursing education.

Dr Nevins noted that immersive reality addresses not only the soft skills related to empathy and patient-centeredness but does so either in person or remotely and in a short amount of time. However, she also noted that more research is needed on the benefits of virtual reality for teaching advance care planning. Downsides include high expenses and the need for technical support due to the lack of familiarity with the products.

Still, Dr Nevins concluded her presentation by making it clear that virtual reality in clinical education is on the horizon and nursing educators should be ready to take advantage of the opportunity to utilize such tools, particularly for teaching communication skills for advance care planning.

Reference:

Nicholson D, Nevins C. Advance care planning conversations: tools for success. Presented at: The 48th Annual Oncology Nursing Society Congress; April 26 – 30, 2023; San Antonio, TX. Accessed April 19, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Session/4943.