Initiating The Conversation – At Home and in Your Community


We Know How! – Here’s a Successful Model

Want to learn to initiate The Conversation? Look no further than La Crosse, Wisconsin, and their nationally and internationally acclaimed program, Respecting Choices.

Through the Gunderson Health System, a team led by Bernard “Bud” Hammes, PhD, and later joined by Linda Briggs, MS, MA, RN, set out to systematically organize a program to instigate conversations about one’s preferences at the end of life. What became known as Respecting Choices has been heralded both nationally and abroad.

The format: to encourage conversations about end-of-life care, effectively document one’s preferences, and to make them available to one’s doctors and loved ones as needed.

This town of 50,000 people decided to not only talk about their preferences for end-of-life care but to get those preferences in writing, and then to act on them.

A sustained, thirty-year community-wide discussion has resulted in La Crosse rising from the national average of one in three people having an Advance Directive, to 96% participation in shared decision-making at end of life.1

Here’s How They Did It

Individually and collectively, the residents of La Crosse broke one of our culture’s most entrenched taboos: discussing death. Why’s the topic taboo? Because initially, the discussion makes people uncomfortable. The antidote: we need to talk about it until the topic becomes routine. A catalyst: the realization that NOT talking about it can lead to untold remorse and anguish.

Throughout La Crosse, residents developed a civic pride in subverting the dominant paradigm. In restaurants, bowling alleys, living rooms, and churches, people began to talk openly about dying and to trust that something good would come of it.

The outcome: a significant cultural change, and a noticeable reduction of physical and emotional duress for both patients and loved ones at the end of life. In addition, La Crosse has the lowest Medicare expenses in end-of-life care in our country.2

Bringing The Conversation into our Communities   

“A person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life should be a national priority.”

                                   – Institute of Medicine, Dying in America

The citizens of La Crosse proved something important. Completing an advance directive is best undertaken not as an onerous task but as a shared journey between loving family members, supported by community and encouraged by local healthcare professionals.

By adding the directive to a patient’s electronic medical record, providers across the care continuum have access to the patient’s preferences. The net result is that people are living out their lives in a manner of their choosing.

Upgrading the System – One Person at a Time

A cornerstone of systems thinking is that we’re each a point of leverage in the healthcare system. Translation: when we act, we trigger change. We make a difference. Are you a caregiver? Encourage the person you’re taking care of to discuss their goals of care. What’s most important to them?

Are you coping with chronic or advanced illness? Choose a person you trust to be your healthcare agent and prepare them to speak up for you when the time comes. Are you a clinician? Learn to become more comfortable asking your patients to think along these lines.

In A Community Near You

Today, Respecting Choices’ model of Advance Care Planning is being implemented in 330 US medical centers in 45 states. Respecting Choices’ evidence-based programs are helping people prepare to make medical decisions while helping clinicians develop the skills to align care with patient’ preferences.

In addition, Respecting Choices is expanding their impact by working directly with healthcare and community organizations to redesign systems, so people get care tailored to what matters most.

Key Components – A Review
  • Let it be a gradual process. A series of non-threatening conversations can lead to more open discussion, and eventually shared decision making.
  • Learn about the value of Advance Care Planning (ACP). Share what you learn with friends and family.
  • Ask and explore “what’s most important?” and plan accordingly.
  • Documentation comes later.
  • Cultural change starts at home: one person, one family at a time, and gradually spreads through the community.
  • Clinicians are learning to become more comfortable initiating The Conversation.
  • When possible, create an advance directive (free forms are available from your doctor) and have the completed form uploaded to your Electronic Medical Record. This allows our choices to be shared across various care settings.
  • Review The Conversation annually with your agent, until it’s a routine part of healthcare, like going to the dentist.
Next Week’s Post: A True Story: “Let It Not Be A Secret” 


A Medical Advice Disclaimer 

The content of this blog is for informational and educational purposes only. No aspect of its contents is intended to substitute for professional medical advice, consultation, diagnosis, or treatment. The author is a spiritual care provider, not a doctor. Always seek the advice of your physician or other qualified health care provider with questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it based on something you have read here.

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Until next week, ‘Safe Journeys,