MARSHFIELD, Wis. — Two Marshfield Clinic palliative care nurse practitioners are encouraging people of all ages to complete advance directives and talk with loved ones about their health care wishes before a crisis happens, saying the conversations can spare families confusion, conflict and delays in care.
Speaking on a recent episode of “Your Health Matters with Marshfield Clinic,” Kim Carolfi and Kris Gilkerson said many patients and families misunderstand palliative care and hospice, often assuming those services mean treatment is ending. Instead, they said, palliative care is designed to support patients and families by managing symptoms, clarifying goals and helping guide medical decisions.
Gilkerson said hospice care generally begins when a patient decides to stop curative treatment and focus on comfort and quality time, often when clinicians estimate a life expectancy of six months or less. Hospice care can be provided at home, in facilities or in hospice homes such as House of the Dove in Marshfield, she said.
Carolfi and Gilkerson said one of the most important steps people can take is completing an advance directive, a legal document that outlines medical wishes and names a health care agent to make decisions if the person cannot. Gilkerson emphasized that in Wisconsin, family members do not automatically have decision-making authority simply because they are a spouse, parent or child.
Without the paperwork, families may need to seek guardianship through the courts, a process the speakers said can take weeks or months at a time when urgent decisions may be needed. They urged people to both complete the form and discuss their wishes with family members in advance.
The practitioners said advance directives are easy to complete and can be downloaded, signed by two qualified witnesses and shared with designated decision-makers and health care providers so the documents can be included in the medical record. They also said the documents should be reviewed and updated after major life changes, including divorce or a serious new diagnosis.
The Marshfield Clinic palliative care team also offers “goals of care” conversations in the hospital and outpatient settings, helping patients and families understand treatment options and decide what interventions are acceptable based on the patient’s values. Those discussions can include CPR, dialysis, feeding tubes, nursing home placement and where a person would prefer to die if given a choice.
Gilkerson said the team’s role is not to persuade patients to choose or refuse treatment, but to support informed decisions and ensure patients understand what specialists are offering. Carolfi added that patients can change their minds at any time, and the team will continue to support those decisions.
The clinicians also described Marshfield Clinic’s inpatient palliative care unit, where staff focus on end-of-life symptom management and family support. Services can include memory-making through the Three Wishes program, spiritual care, social work, nutrition support and other efforts tailored to a patient’s final wishes.
Among the most common misconceptions, they said, is that a palliative care consult means a patient is “giving up” or that insurance will not cover palliative care services. The team said palliative care is an added layer of support and is covered by insurance.
Their central message: talk early, document your wishes and revisit them over time.
“The greatest gift we can give our loved ones is having that conversation so they know exactly what we want,” Gilkerson said, adding that honoring those wishes can also be a gift in return