What advance care planning is
Advance care planning conversations are talks about your values, the medical care you would or would not want in a serious illness, and the person you trust to make decisions if you cannot. They are for any adult, not only people who are seriously ill.
There are two parts. The first is the conversation itself, with the people close to you and with a clinician who knows your health. The second is paperwork, usually called an advance directive, that records your choices and names a decision-maker.
Planning is not a one-time event. What you want can change as your health changes.
Why primary care is a good place to start
Many of these conversations happen in a hospital hallway during a crisis, with tired relatives and little time. A primary care visit at home is calmer. The people you want are beside you or on the phone, and nothing has to be decided that day.
A primary care clinician also knows the whole picture: your conditions, how they are likely to progress and what different treatments can realistically do. Some people raise the topic during an annual wellness visit.
What a goals of care conversation covers
Expect questions such as:
- What do you understand about your health right now, and what would you like to know?
- What matters most to you: staying at home, being independent, being comfortable, having more time?
- What would you be willing to go through for the chance of more time, and what would be too much?
- How do you feel about hospital stays, intensive care, breathing machines and CPR?
The clinician can explain what each treatment involves and how it tends to go for someone in your situation. Our list of conversation starters can help you think beforehand.
How your goals shape wound care and recovery
For most people with a wound, the goal is healing, and the plan is built around it. Your wider goals still affect the choices along the way. Someone who wants above all to stay at home may prefer a plan with fewer trips to appointments.
When a person has an advanced illness, some wounds cannot heal. The focus then turns to comfort: easing pain, managing odor and drainage, and keeping dressing changes gentle. Gateway arranges palliative wound care with Gateway clinicians for that purpose, and our guide to wound care and comfort goals at the end of life is written for families.
In each case, the wound care team does better work when it knows your goals and knows who speaks for you.
Choosing the person who will speak for you
The person you name is often called a health care agent or a health care power of attorney. Choose someone who:
- Knows you well and will follow your wishes, even where they would choose differently
- Can be reached quickly and can stay calm under pressure
- Has agreed to take the role
Then tell that person in detail what you want.
Documents, and what we cannot advise on
Advance directive forms and the rules for signing them differ by state, and Missouri and Illinois each have their own. Gateway does not give legal advice or prepare legal documents. An attorney can answer legal questions. A clinician’s office or a hospital social worker can often point you to standard forms.
Once documents exist, make them easy to find:
- Give copies to your agent, your primary care clinician and any hospital you use.
- Keep one at home where family can find it quickly.
- Review it after a new diagnosis, a hospital stay or a change in your family.
What Gateway arranges
Gateway coordinates primary care follow-up with Gateway clinicians across Greater St. Louis and the Metro East, keeps your existing physician involved, and helps connect you with a practice if you do not have one.
For advance care planning, we can tell the treating clinician ahead of time that you want to talk about it, so the visit allows for it. We can help family members join by phone. With your permission, we let the wound care team know that documents exist and who your agent is. Our guide on who can receive updates explains how permission works.
How to start
Call 314-325-0126 or request a callback with a name and phone number. Tell us on the call that you want time for a planning conversation. In an emergency, call 911.
Common questions
Is advance care planning only for people who are dying?
No. It is for any adult, and it is easier while you are well enough to think clearly and talk with family. An accident or sudden illness can leave anyone unable to speak for a time. Planning early means the people around you know what you want and are not left to guess.
Does having an advance directive mean I will get less care?
No. An advance directive records your wishes for situations in which you cannot speak for yourself. It can ask for every available treatment, set limits or sit somewhere in between. While you can make your own decisions, clinicians ask you directly. It does not change the care you receive for a wound today.
Do I need a lawyer to complete an advance directive?
Many people complete standard forms without one, but the requirements for signing and witnessing differ by state, and Gateway cannot give legal advice. If your family situation is complicated, or you question whether a document is valid, ask an attorney. The treating clinician can help with the medical questions behind your choices.
What if my family disagrees with what I want?
That is a strong reason to talk now. Naming one agent and explaining your reasons to everyone reduces conflict later. If the conversation is hard, ask the treating clinician to hold a family discussion during a visit. Hearing the medical facts from a clinician can help relatives accept a choice they would not make themselves.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.