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How to Wisely Choose End of Life Care

If your loved one requires end of life care in San Francisco and elsewhere, your first thought may be: where do I start? It can certainly be an overwhelming prospect due to all the stress, sadness and suddenness of it all. Your loved one’s nurses and doctors are excellent resources, but their recommendations can only go so far. Is there an across-the-board directive that can provide solid, evidence-based recommendations for healthcare providers to give to families? The answer is yes. We’ll take a look at the perspectives of both healthcare providers and the families as each entity tries to make the best possible decision for the patient.

Recommendations for Interventions

A group of professional organizations has come up with some recommendations that help doctors and patients make wise decisions about interventions at end of life. It’s called Choosing Wisely® and it’s an initiative of the American Board of Internal Medicine (ABIM) Foundation with a goal of facilitating communication between patients and clinicians when it comes to overused tests and procedures. In fact, it focuses on providing care that will meet the following criteria:

  • Evidence-based.
  • Does not duplicate other care already received.
  • Causes no harm.
  • Necessary.

The guidelines are all designed to ensure all interventions are both necessary and appropriate for the patient. More than 40 national organizations currently partner with the ABIM Foundation in the Choosing Wisely initiative, ranging from medical associations like the American Academy of Family Physicians to consumer-related organizations like Consumer Reports Health.

There’s even a Choosing Wisely app that you can download on your iPhone or Android device, containing more than 500 specialty society recommendations and 150 patient-friendly resources.

As part of the initiative, national organizations representing medical specialists request members to identify common tests and procedures used in their field that don’t necessarily have to be utilized. The result is a specialty-specific list of “Things Providers and Patients Should Question.” And to help patients approach their healthcare provider in these conversations, empowering them to ask questions about what tests and procedures are right for them, Choosing Wisely has also come up with patient-friendly materials. These draw from the specialty societies’ listings of recommendations of tests and treatments considered possibly unnecessary.


For patients and family members, it can be overwhelming choosing the right end of life care provider. There are many considerations to think about, such as how much treatment you want at end of life (feeding tubes, breathing machines, etc.), if you want a do-not-resuscitate (DNR) order, and if you want to donate your organs.

End-of-life choices are the hardest ones you’ll ever have to make. Not only do you have to face your own mortality or that of someone you love very much, but you also have to make practical, medical and legal decisions in the midst of it all, points out WebMD. One way to make sense of what you want is to talk with people about it, from family and friends to doctors and even lawyers. Each one can help in different ways.

Family and Friends:

  • Bring up a related topic, such as if you recently updated your will.
  • Share your values about a life. i.e., what gives meaning to you, what your beliefs are, and how you feel about the dying process.
  • Tell them what triggered these thoughts, such as an event, article, program or the death of someone close to you.

Doctors: When you see your doctor and the rest of your healthcare team, ask about all your end-of-life choices. It may be easier to talk about such a serious topic when it’s in a clinical setting with fewer emotions involved. Your doctor should be able to walk you through the pros and cons of common issues surrounding end of life decisions.

Lawyers: It’s important to make your wishes clear, and you can achieve that through something called “advance directives.” You’ll want to come up with a living will, which notifies doctors of the type of care you want at the end of life. Next, you’ll need a health care power of attorney, which names your health care agent who will make all health-related choices for you.

Choosing the right environment in which to engage in hospice or end of life care is also imperative. Select a few providers, take tours, meet the healthcare team, ask questions and research the background of the provider or facility. This can be draining, especially when faced with such an overwhelming situation. However, in order to receive the right care, you need to do your due diligence.

Contact Pathways Home Health and Hospice

You’ll find caring and compassion people here at Pathways Home Health and Hospice. Contact us at 888-978-1306 to ask any questions about our team, level of care, and services. Get in touch today.