Advance directives: when, why, and how to start talking.

Advance directives allow patients to influence their medical care after they have lost decision-making capacity. As it is impossible to predict a life-threatening event, physicians should address advance directives with every patient during routine office visits. To make informed decisions, patients must understand their options, such as CPR and artificial nutrition and hydration. Similarly, physicians need to understand patients' values and goals, in order to counsel proxy decision-makers and guide their patients' care. Two office visits are recommended; experienced physicians can usually accomplish the initial conversation in less than 10 minutes and the follow-up in less than 5 minutes. Because opinions and circumstances change, these documents should be reviewed annually.