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Events to focus on education about advance directives

Apr. 4, 2019, 9:24 AM

Mohana Karlekar, MD, medical director of the Palliative Care program, right, teaches medical and nursing students about how to have positive conversations with patients about advance directives for healthcare.
Mohana Karlekar, MD, medical director of the Palliative Care program, right, teaches medical and nursing students about how to have positive conversations with patients about advance directives for healthcare. (photo by Jill Clendening)

by Jill Clendening

Health care professionals throughout the United States are encouraging patients and their families to document their preferences related to their health care during an awareness campaign known as National Healthcare Decisions Day, celebrated on Tuesday, April 16. Vanderbilt University Medical Center is hosting several events for employees to promote the importance of completing an advance directive for health care.

An advance directive is a legal document that informs family, caregivers and providers about a patient’s preferences for care. It also names an individual or individuals to serve as a health care decision maker on their behalf if they become unable to do so.

Once an advance directive is completed, it is typically added to the patient’s electronic health record (EHR) so a patient’s wishes are available to all providers involved in their treatment.

“An advance directive is a vital step in declaring your health care preferences and gives you a voice if you’re ever not able to speak for yourself,” said Bonnie Miller, MD, MMHC, Senior Associate Dean for Health Sciences Education at Vanderbilt University School of Medicine and Executive Vice-President for Educational Affairs at VUMC.

“We want all staff and faculty to complete an advance directive for their own personal benefit, but also because we want them to be comfortable encouraging their family, friends and patients to complete one of their own. Ultimately, we want everyone in our community to be aware of the importance of advance care planning and to complete an advance directive.”

While medical providers and patients typically agree that it makes sense to have medical wishes well documented in advance of a health crisis, according to research published in 2017 in Health Affairs, a leading health policy and research journal, just 36.7% of adults in the United States have completed an advance directive for health care of any kind.

In 2018, when faculty, staff, students and volunteers from VUMC and Vanderbilt University were asked about their own advance directives, the number was a bit lower. Of the 2,185 individuals surveyed, 27% had completed advance directives, although 77% thought they should have one. Eighty-two percent of those who felt that they didn’t need one were younger than 35.

Improving end-of-life care and encouraging conversations between clinicians and patients about advance directives and goals related to their quality of life (also known as goals of care) have been an increasing focus at health care institutions nationwide. At VUMC, a special committee established in 2018 and led by Miller is spearheading efforts to both educate Medical Center staff about the importance of having their own advance directives completed, and to provide guidance to clinicians as they initiate these often-difficult conversations with patients and patients’ families. The efforts also include expanding medical and nursing school training related to advance directives and end-of-life care.

“It’s so important that we, as Medical Center employees, practice what we preach when it comes to completing an advance directive and planning for end-of-life care,” said Mohana Karlekar, MD, medical director of VUMC’s Palliative Care program.

“Many of us here at VUMC witness firsthand just how vital it is to have a patient’s wishes documented so care can be provided that is in sync with their personal values. These events will support employees as they can have questions answered and complete advance directives that they can then share with their loved ones.”

VUMC events on April 16, National Healthcare Decision Day, include:

  • Inpatient rounds with leadership, 11 a.m.-1 p.m., at Vanderbilt University Adult Hospital and Monroe Carell Jr. Children’s Hospital at Vanderbilt. Kate Payne, JD, RN, NC-BC, from the Center for Biomedical Ethics and Society, and members of the Palliative Care team will visit adult hospital nursing stations to distribute advance directive forms and information sheets, and to answer questions about advance care planning. Kelly Harris, MD, a third-year pediatrics resident, will lead these efforts at Children’s Hospital.
  • Information table, 10 a.m.-2 p.m., in the lobby outside Au Bon Pain in the adult hospital. Information sheets and advance directive forms will be available, and staff will be on site to answer questions about advance care planning.
  • Lecture, “National Healthcare Decisions Day: Making Your Wishes Known,” 4 p.m., at 202 Light Hall. Karlekar and Payne will speak, and CME and CNE credit will be available. The lecture will be streamed live and recorded at

To learn more and to find advance directive forms for Tennessee, visit

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