How do you support families in making difficult decisions, such as those related to advanced directives or do-not-resuscitate (DNR) orders?

Depends on if the patient can make those decisions. If I’m working with the NOK I’m asking what they think their loved one would want, I ask what a good day would be to their loved one and if the disease process will stop them from ever having that sort of “good day” then I educate on the difference between quality of life vs quantity of life. From their they normally come to terms with what decision they have made. The reality is they normally make the decisions before we ask any questions; I remind them of why they have made those decisions.

If I’m working with the patient it’s easier. They speak for themselves and know what they love about life. I’m asking the same questions but asking “what is a good day to you” instead of them guessing what their loved one thought.

If I’m talking with the NOK or the patient, I keep my focus in learning what the patient enjoyed in life, and educate patient/family how their current condition is going to effect their ability to enjoy these things.

And remember; sometimes the answer (even in hospice) is stay full code for now and re-evaluate the decision later. They may not be ready to sign a DNR today, but they might literally be ready tomorrow. Just ensure they know and understand what happens during a code, and the most likely outcomes of CPR/intubation.

I try - as gently as possible - to educate them about what usually happens to an elderly and/or fragile person when CPR is performed. I ask them if they think that is something their loved one would want to go through. I also let them know that they can tear up the DNR at any time. It’s rare that they don’t see that the best option is to execute a DNR.