Advance care planning is important for all adults at all stages of life and health and is an important part of routine, high-quality healthcare.

Advance care planning involves making decisions about the healthcare you would want to receive if you were facing a medical crisis in the future and were unable to communicate your own treatment preferences.   These are your decisions to make based on your personal values and preferences. 

The goal of advance healthcare planning is to help ensure that individuals receive medical care that is consistent with their values, goals, and preferences.  The nature of the advance care planning conversation may vary depending on whether the person is healthy, has mild to moderate chronic illness, or has an advanced life-limiting condition and is thought likely to die within the next one to two years.

Advance healthcare planning includes:

1. Thinking about your values, wishes, and beliefs regarding quality of life.
2. Learning about possible future health conditions, the types of life-sustaining treatments that are available, and what these treatments can and cannot do.
3. Choosing a healthcare representative. A healthcare representative is someone who is willing and able to speak for you and make healthcare decisions for you if you become unable to communicate or make decisions for yourself in the future.
4. Talking with your healthcare representative, loved ones, and healthcare providers about the types of treatment you would or would not want should you be faced with a medical crisis and be unable to make your own decisions (e.g., head injury, stroke, coma, etc.).
5. Completing advance directives, which put into writing whom you choose to be your healthcare representative and the types of treatment you would or would not want should you be faced with a medical crisis and be unable to make your own decisions (e.g., head injury, stroke, coma, etc.).

Advance Care Planning conversations and completion of advance directives are reimbursable by Medicare.

Resources:

Centers for Medicare and Medicaid Services (CMS) – Advance Care Planning Fact Sheet
End of Life Care Conversations: Medicare Reimbursement FAQs – Conversation Ready

If any of us became seriously ill, those closest to us may have to make important decisions about our care.  Talking about our healthcare wishes can make future decisions easier – a gift we can give to those who matter most to us.  We may not be able to predict every decision that needs to be made, but we can give those we love the guiding principles to confidently make decisions for us.

ACP conversations put you in the healthcare driver’s seat.  Getting the medical care we need often involves decisions, and we can and should speak up about the kind of care that works for us.  Speaking up about the kind of care we want also means telling those closest to us what we would want if we couldn’t make decisions for ourselves.  We are not doctors, but we ARE the experts on what is right for us and our lives.  When we share our values, preferences and wishes with our doctors and loved ones, we are part of the team that helps us get the right care for us.   We have a right to have a say in our health care. 

ACP conversations bring clarity and peace of mind.  The future is full of unknowns. But open conversations can pave the way to clarity, no matter what happens with our health or the health of our loved ones.  Having conversations about serious illness and the kind of care that is right for us gives us a shared understanding that fosters peace of mind.  We cannot plan for everything.  But we can help manage life’s unknowns by talking openly about what matters to us and what we would want most if we became seriously ill.  Conversations about things we cannot control can help give us a sense of control. 

ACP conversations help us learn what matters to our loved ones.  There may be a time when we must help the people closest to us—our friends, our spouses, our parents, or grandparents—get the care that is right for them.  To ensure our loved ones get the care that is right for them, we have to understand their values, preferences, and needs by making conversations a priority.  Asking those closest to us about what they would want in the face of a serious illness is a way to show them we care. 

ACP conversations can strengthen relationships.  The trust involved in having conversations about healthcare wishes and what matters most, can bring us closer.  The more we talk about the kind of care our loved ones want and expect, the more comfortable it becomes for all of us.    And it helps prepare us to be the best support we can be.

ACP conversations can help prevent stress and discord in families.  Making end-of-life decisions for loved ones is very difficult, emotional, and stressful, and family members may have different perspectives about the best course of action.  You can help ease the pressure of their future decision making by sharing your wishes with them in advance of a crisis. 

Research shows other ACP benefits.  Research shows that patients, family members, staff, and medical providers all benefit from advance care planning.  In prospective studies and randomized trials, advance care planning has significantly improved multiple outcomes, particularly for patients with serious illness.  These include:

• ACP helps ensure that patients receive care that is consistent with their preferences and the Patient Self-Determination Act of 1990.
• ACP increases the likelihood that clinicians and families understand and comply with a patient’s wishes.
• ACP increases the likelihood that a patient will die in his/her preferred environment.
• ACP improves communication between patients, loved ones, and clinicians resulting in shared decision-making.
• ACP is associated with higher patient and family satisfaction with the quality of medical care received.
• ACP lowers the risk of stress, anxiety, and depression in surviving loved ones.
• ACP provides guidance to family members and reduces their decisional burden about whether they are following their loved ones’ preferences.  Family members feel better prepared to make decisions for their loved one.  Family is better prepared about what to expect during the dying process.
• ACP reduces moral distress among health care providers.
• Emerging data indicates advance care planning reduces the cost of end-of-life care, without increasing mortality.

The nature of ACP may vary depending on whether the person is healthy, has mild to moderate chronic illness, or has an advanced life-threatening condition and is thought likely to die within the next one to two years. In an ideal ACP discussion, clinicians, the patient, and his or her loved ones think through particular approaches to follow if (or when) the patient’s health declines. These discussions will then drive specific medical treatment decisions that can be expressed and recorded in several types of legal documents called advance directives. Advance Care Planning can be viewed as occurring over a person’s lifetime in different stages.

STAGE ONE: No serious illness

Target Population: All adults who have not yet made plans.
Tasks for the patient to complete at this stage:

STAGE TWO: Serious Illness

Target Population: Individuals with serious illness. These persons may have complications from advancing illness, co-morbidities, frequent clinical encounters, and/or functional decline.
Goal: Identify treatment preferences if illness complications or treatments would result in unacceptable outcomes and a poor quality of life as defined by the person. Communicate preferences with healthcare representative, loved ones, and healthcare providers.

Tasks for the patient to complete at this stage:

STAGE THREE: Advanced Serious Illness

Target Population: Adults with serious injury or illness or advanced frailty, whose healthcare professionals would not be surprised if they died in the next one to two years.
Goal: Identify treatment preferences if illness complications or treatments result in unacceptable outcomes and a poor quality of life as defined by the person. Communicate preferences with healthcare representative, loved ones, and healthcare providers.

Tasks for the patient to complete at this stage:

The advance care planning (ACP) facilitator is an emerging role in routine, high-quality healthcare.  ACP facilitators are instrumental in helping individuals, their families, and their loved ones become more engaged in person-centered decision-making. The role of the ACP facilitator is a critical component of any program seeking to achieve the goal of advance care planning —to know and honor an individual’s informed healthcare decisions. 

Helping Individuals Make Informed Healthcare Decisions:  The Role of the ACP Facilitator

Because advance care planning is not a one-size-fits-all conversation, ACP facilitators benefit from training to have conversations with individuals at different stages of health and in different settings of care.  The Putnam County Hospice and Palliative Care Association is offering training in the Respecting Choices First Steps Advance Care Planning Facilitator Certification program. 

Connect your patient with a trained local facilitator by contacting the Putnam County Hospice and Palliative Care Association at This email address is being protected from spambots. You need JavaScript enabled to view it.. 

Putnam County Hospice and Palliative Care Association provides training and support for local advance care planning (ACP) facilitators.  Contact the Association at This email address is being protected from spambots. You need JavaScript enabled to view it.  to inquire about training opportunities.  

To connect with a local ACP facilitator, please click here. 

To make your healthcare decisions and preferences legal, you should complete an advance directive.  There are three sections of an advance directive.

1. Choosing a healthcare representative. The first section of an advance directive involves choosing your healthcare representative. In Indiana, a healthcare representative is someone chosen by a person to make his or her healthcare decisions, including end-of-life decisions, in the event the person becomes unable to make his or her own decisions in the future.  In most states, a doctor determines if a person is unable to make his or her own decisions.

It is important you choose someone you trust to make healthcare decisions for you should you become unable to make your own decisions in the future.  It is important to think carefully about this decision. There are four qualities you should look for.  A healthcare representative should be willing to:

• • Accept this role.
  • Talk with you about your goals, values, and preferences.
  • Follow your decisions, even if he or she may not agree with them.
  • Make decisions in difficult moments.

Most experts recommend that a person chooses a primary and a secondary healthcare representative.  The secondary representative will make decisions if the first is unable to do so.  Some people may wish to identify multiple healthcare representatives to serve simultaneously; however, this option should be chosen cautiously because of the potential for disagreement and conflict among your representatives. 

If you do not appoint a healthcare representative, Indiana law determines who will make decisions for you.  These persons are called “Proxy Decision Makers,” and they are identified in hierarchical order in the Indiana Code:  IC 16-36-1-5.   To see the hierarchy visit Indiana Advance Directive Forms on this site.

Please note:  As of January 1, 2023, Indiana law no longer recognizes the terms “healthcare power of attorney,” or a “medical power of attorney,” on new advance directives.  However, if advance directive documents utilizing these terms were legally completed prior to January 1, 2023, they do NOT have to be revised.  They are grandfathered and remain legally valid.  

2. Providing a statement of healthcare wishes or preferences. The second section of an advance directive has also been called a “living will,” and can be as brief or detailed as a person wishes. It should at least address the person’s preferences for being kept alive with artificial means if the person has little to no chance of recovering to the point of being able to make decisions for themselves again.  There are many tools available to help people think and talk about the various decisions and choices that might be included in this section of an advance directive.   
    
3. Obtaining legally required signatures in accordance with state law. To be legally valid, an advance directive must be signed and witnessed. Every state has its own laws governing advance directives, and unfortunately, what this means is that an advance directive that is legally valid in one state may not be valid in another state. 
   
   In Indiana, a legally valid advance directive requires your signature, plus signatures from two adult witnesses OR a notary.  One of the two adult witnesses must not be a relative.  If you travel frequently and / or have homes in different states, it is recommended that you obtain signatures from BOTH two witnesses AND a notary so that your advance directive will be legally valid in all states. 

After doing the hard work of creating advance directives, it is absolutely vital that you make your documents known and accessible.  There is no benefit to having an advance directive if no one knows that it exists or where it can be easily located.   For persons with advanced serious illness, a copy of your advance directive with signatures must be immediately accessible and producible in the event of a medical emergency. 

After you have obtained the necessary witnesses and signatures on your advance directive documents, please take the following steps to ensure the accessibility and usefulness of your advance directives:

1. Make copies of your advance directives.
2. Put the original advance directives in a secure, fireproof location.
3. Keep one copy in an easily accessible location, that is known to your healthcare representative and your loved ones. In Putnam County, Indiana, you should keep them in your Vital Medical Information File, a bright red envelope that has a magnet and hangs on your refrigerator. All emergency responders in Putnam County know to look for this bright red envelope on a person’s refrigerator. 
4. Provide copies to your healthcare representative and other appropriate individuals (i.e., physicians, loved ones, clergy, attorney, etc.).
5. Discuss the details of your advance directive with these individuals.
6. Ask your physician to make your advance directive a part of your permanent medical record.
7. Whenever you go on a trip, to the doctor, or to the hospital, take a copy with you. You may want to consider keeping a copy in your wallet or purse, along with the contact information for your healthcare representative. 
8. You may wish to consider putting a card in your wallet or glove box that states that you have an advance directive, identifies your healthcare representative, and provides his/her contact information.

It is normal for personal healthcare preferences to change as medical science advances and as a person’s age, health, and life-situation changes.

Good advance care planning for healthcare is always a continuing conversation and a work in progress.  That’s because circumstances change, and lives change.  One’s values and priorities may even change.   If you are mentally competent and able to communicate, you may change or cancel your advance directive at any time. 

The American Bar Association recommends that individuals revisit and discuss their advance care plans and documents whenever any of the “six Ds” occur:

1. You reach a new DECADE in age.
2. You experience the DEATH of a loved one.
3. You experience a DIVORCE.
4. You receive a DIAGNOSIS of a significant health condition.
5. You experience a significant DECLINE in your functional condition.
6. You change your DOMICILE, or someone moves in with you.

Advance care planning for healthcare is an important part of routine, high-quality health care and financial planning for all adults in all stages of life and health. 

If you would like assistance with advance care planning, you are not alone.  Fortunately, there is a variety of assistance available - some of which is free of charge.  See various options below, and don’t hesitate to contact the Putnam County Hospice and Palliative Care Association with your questions.  Call 765.301.7614 or email This email address is being protected from spambots. You need JavaScript enabled to view it.. 

• Online.  There is a wealth of free, high-quality resources available online to assist people to engage in advance care planning conversations and complete advance directives.  Many of these resources are identified on this website in Advance Care Planning Resources sections.
  
  
• Putnam County Hospice and Palliative Care Association.  People receiving health care in Putnam County, Indiana, are fortunate to have the Putnam County Hospice and Palliative Care Association, which offers free, individualized, convenient advance care planning assistance and a variety of free resources to help with both advance healthcare planning as well as living with a serious illness.  Call 765.301.7614 or email This email address is being protected from spambots. You need JavaScript enabled to view it. to set up an appointment.  If possible, it is important to include your healthcare representative and/or other loved ones in these conversations. 
  
  
• Your healthcare provider.  Advance care planning for healthcare is an important part of routine, high-quality health care, and your healthcare provider will be able to provide you with information and guidance that is specific to you and your health status. This assistance may be offered in a variety of settings, such as an office, nursing facility, home, and through telehealth means. Advance care planning conversations and completion of advance directives are covered by Medicare, Medicaid, and some other insurance providers, and it is likely that there will be no charge to you. If possible, it is important to include your healthcare representative and/or other loved ones in these appointments.
  
  
• Your attorney.  Although advance directives do not require an attorney, you may wish to consult with one as you prepare your advance directives.  For example, an attorney may be helpful in advising you on complex family matters, protecting you if you live in multiple states, or ensuring that advance directives prepared in another state are recognized in Indiana.  Unless your attorney provides pro bono services, there will be a charge.  But for people with complicated family and financial situations, this expense may be well worth it. If possible, it is important to include your healthcare representative and/or other loved ones in these meetings. 

Starting an advance healthcare planning conversation with patients can be challenging and time consuming. Here are some helpful resources.

CLICK ON THE LINKS BELOW FOR TOOLS AND INFORMATION:

• Getting the Conversation Started - Brief Script – PREPARE (pdf)
• Having the Conversation at three life stages:  A Guide for Practitioners – Conversation Ready (pdf)
• Advance Care Planning: Using the Health Care Team to Make Hard Conversations Easier
• IHI - Conversation Ready White Paper - This white paper presents a framework built on five core principles to help healthcare organizations and clinicians develop reliable processes to engage patients in conversations about their wishes for end-of-life care, steward that information, and provide respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.
• Improving Advance Care Planning Documentation Using Reminders to Patients and Physicians: A Longitudinal Study in Primary Care – American Journal of Hospice and Palliative Medicine
• Working Together to Improve Advance Care Planning in Healthcare and Community Settings – Respecting Choices and PREPARE (pdf)

Advance Care Planning conversations and completion of advance directives are reimbursable by Medicare.  Other payers frequently adopt Medicare billing and payment rules, but they are not required to do so.  Providers of patients enrolled in a Medicare Advantage plan or other payers will have to check directly with the health plan carrier to determine if the Medicare codes are payable by the carrier.

Cost to patients.  All Medicare beneficiaries are entitled to an annual wellness visit (AWV) which does not have any cost-sharing liability for the beneficiary.  If the ACP discussion is part of the AWV, there is no Part B coinsurance or deductible payment. Since ACP services are voluntary, when a beneficiary (or family members and/or surrogate) elects to receive ACP outside the AWV, CMS encourages practitioners to notify patients that Part B cost sharing will apply as it does for other physicians’ services.  Clinicians should communicate with their organization’s billing office for billing specifics.

CLICK ON THE LINKS BELOW FOR MEDICARE INFORMATION AND RESOURCES:

• Medicare codes for ACP Conversations - Bill Dunbar and Associates (pdf)
• Putnam County Hospital Annual Wellness Visit Toolkit 2023 (pdf)
• Centers for Medicare and Medicaid Services (CMS) – Advance Care Planning Fact Sheet
• CMS clarifies advance care planning coding and billing requirements – American Academy of Family Physicians (AAFP)
• Advance Care Planning: Discussion Guide and Visit Documentation Form – AMDA
• End of Life Care Conversations: Medicare Reimbursement FAQs – Conversation Ready (pdf)
• FAQs – Advance Care Planning Under Medicare – Coalition for Compassionate Care (pdf)

The POST form is designed to help physicians, physician assistants, nurses, long-term care facilities, hospices, home health agencies, emergency medical services, and hospitals:

• promote patient autonomy by documenting treatment preferences and converting them into a medical order.
• clarify treatment intentions and minimize confusion regarding a person’s treatment preferences; and
• facilitate appropriate treatment by emergency medical services personnel.

The Indiana POST is a part of the National POLST initiative, which is an approach to advance care planning for patients who are at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty.  The POLST process emphasizes eliciting, documenting, and honoring patients’ preferences about the treatments they want to receive during a medical emergency or as they decline in health. These treatment wishes are documented on a portable medical order called a POLST form. 

CLICK ON THE LINKS BELOW FOR ADDITIONAL POST INFORMATION:

• The Indiana POST Program
• The Indiana POST Program – FAQ’s
• Using the Indiana POST Form: Guidance for Health Care Professionals
• POST Cover Sheet for Patients (pdf)
• POST Revocation Checklist for Patients (pdf)
• Indiana POST information for patients
• Indiana POST and Advance Directives for EMS Guide
• Appropriate Use of POLST in Long-Term Care (pdf)

There are many tools and resources for healthcare organizations, providers, and patients in the challenging work of ensuring that patient’s healthcare wishes are honored throughout life. 

CLICK ON THE LINKS BELOW FOR ACP RESOURCES FOR HEALTHCARE ORGANIZATIONS, PROVIDERS, AND PATIENTS.

Advance Care Planning Decisions

provides a library of tools and videos designed to help healthcare providers and administrators efficiently provide advanced care planning services and improve the quality of end-of-life care.  The tools are in multiple languages.  The ACP Decisions Video Library consists of over 280 videos in 20 different languages. They address a range of issues and fall under three categories: Video Decision Aids, Free Standing Educational Videos, and Caregiver Videos.  https://www.acpdecisions.org/

Caring Conversations Workbook.  Published by the Center for Practical Bioethics, the Caring Conversations® Workbook and related materials guide persons and their loved ones through the process of advance care planning with a highly individualized focus.  Information is also available about the POLST advance directive. Materials may be downloaded for free for personal use from the website: https://www.practicalbioethics.org/featured-resources/caring-conversations-2/

Consumer's Tool Kit for Health Care Advance Planning.  Prepared by the American Bar Association’s Commission on Law and Aging, this Tool Kit contains a variety of self-help worksheets, suggestions, and resources. There are currently 8 tools in all, each clearly labeled and user-friendly. The Tool Kit does not create a formal advance directive for you.  Instead, it helps you do the much harder job of discovering, clarifying, and communicating what is important to you in the face of serious illness. The Tool Kit is available for free download at: https://www.americanbar.org/content/dam/aba/administrative/law_aging/2020-tool-kit-hcap.pdf

Five Wishes for Healthcare Organizations – a program of Aging with Dignity The Five Wishes Program for Healthcare offers a suite of tools and resources for healthcare providers, including accessible clinical training, consulting, and custom-built virtual solutions.   The program works for large health systems, hospices, long-term care, clinics, physicians, and all other practice settings - because you choose which components are right for you. https://www.fivewishes.org/healthcare/

The Five Wishes Advance Directive is an easy-to-use legal advance directive document written in everyday language. It helps all adults, regardless of age or health, to consider and document how they want to be cared for at the end of life.  It addresses all of a person's needs: medical, personal, emotional and spiritual.  The advance directive and guide are available in thirty languages and in Braille.  It is available digitally and on paper for a nominal fee.  Digital versions can be electronically signed and witnessed and customized to meet legal requirements in all 50 states.  The digital service offers unlimited updates.  The paper version is legal in all states except New Hampshire, Kansas, Ohio, and Texas.  https://www.fivewishes.org/about-five-wishes/

Institute for Healthcare Improvement (IHI) - Conversation Ready Initiative  The IHI "Conversation Ready" approach seeks to help healthcare organizations and clinicians provide respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.  The framework is relevant whether you are a leader in a large hospital, a social worker in the community, a doctor in a clinic, or a palliative care nurse in a skilled nursing facility.  https://www.ihi.org/resources/white-papers/conversation-ready-framework-improving-end-life-care

PREPARE - Prepare for your Care  This free website is designed to help people and their loved ones prepare for medical decision-making by guiding the user through five easily understandable steps.  PREPARE has 2 programs with video stories to help you:  1) Have a voice in your own medical care; and 2) Help other people with their medical planning and decisions.  The Prepare program, videos, and materials have been researched and found to be successful.  Multiple video aids are available.  Legal advance directives are provided for all fifty states in both English and Spanish.  Advance directives in Chinese are available for some states.   You may print and complete on paper, or complete online and print.  There are also scripts and tools available for healthcare providers and organizations. https://prepareforyourcare.org/en/welcome

Respecting Choices Respecting Choices seeks to provide a system for person-centered decision-making that will transform healthcare systems.  Respecting Choices guides organizations and communities worldwide to integrate and disseminate evidence-based best practices that ensure individuals’ preferences and decisions for healthcare are known and honored. They offer evidence-based training for advance care planning.   Respecting Choices has an array of educational programs to support an organization or community transform to a person-centered healthcare culture. The curriculum includes both communication skills and education for health professionals and others as well as design and integration strategies for improving systems and workflows to make person-centered goals the routines of care.  https://respectingchoices.org/

The Conversation Project  The Conversation Project® is a public engagement initiative of the Institute for Healthcare Improvement (IHI).  It is dedicated to helping everyone talk about their wishes for care through the end of life, so those wishes can be understood and respected.  Resources include seven workbooks that may be downloaded for free.  They offer guides for talking with special populations such as persons with dementia, children, and persons with serious illness. The Conversation Project also has a guide to help people talk to their healthcare providers.  The Conversation Project provides resources for healthcare providers, faith leaders, and communities.  https://theconversationproject.org/  

Wisconsin Medical Society - Honoring Choices Wisconsin   (HCW) is an initiative of the Wisconsin Medical Society to build system change, advocacy, and education around advance care planning. Through HCW, the Society serves as convener, coordinator and catalyst to make advance care planning a routine and standard part of health care across Wisconsin.  The Medical Society provides clinical training and guidance, encourages healthcare system collaboration, increases physician engagement, and develops common language and tools. https://www.wismed.org/wisconsin/wismed/about-us/honoring-choices/wismed/about-us/honoring-choices.aspx?hkey=05044a12-ed7d-47c7-95e5-f9d697ffdf27

Patients and clinicians have different expertise when it comes to making important clinical decisions.  While clinicians know information about diseases, tests and treatments, patients know information about their bodies, their circumstances, and their goals for life and healthcare.  The process of sharing in the decision-making tasks involves developing a partnership based on empathy, exchanging information about the available treatment options, considering the potential consequences of each one, and deciding medical treatments collaboratively.

CLICK ON THE LINKS BELOW FOR ADDITIONAL INFORMATION ABOUT SHARED DECISION MAKING.  

The Mayo Clinic’s Shared Decision-Making National Resource Center is called Care That Fits.  The Shared Decision-Making National Resource Center advances patient-centered medical care by promoting shared-decision making through the education and the development, implementation, and assessment of patient decision aids and shared decision-making techniques.  It is involved in setting international standards for patient decision aids, establishing state-wide shared decision-making practices, and promoting national and international dialogue about patient-centered care.  The website provides free tools and videos for use by doctors and patients when treatment decisions are needed for a variety of medical conditions.  https://carethatfits.org/

Respecting Choices   Respecting Choices® is an internationally recognized, evidence-based model of advance care planning seeking to create a healthcare culture of person-centered care—care that honors an individual’s goals and values for current and future healthcare.  The complete Respecting Choices model offers advance care planning and shared decision-making education for clinicians.  https://respectingchoices.org/  

Click on the links below for Respecting Choices decision aids. 

• User Guide for Decision Aids
• Help with Breathing Decision Aid
• Cardiopulmonary Resuscitation (CPR) Decision Aid
  

VitalTalk    VitalTalk is a training organization for clinicians seeking to communicate effectively with seriously ill patients and their families.  VitalTalk provides evidence-based training to empower clinicians and institutions.  The website offers many resources, including free one-page quick guides that offer actionable insight.  There are also options for more comprehensive training both online and in-person on such topics as “Delivering Serious News,” and “Navigating Serious Conversations.”  https://www.vitaltalk.org/

Patient decision aids (PDAs) are support tools designed to provide patients with relevant information to help them make informed decisions about their healthcare.  Decision aids make explicit the decision that needs to be made, provide information about treatment options and outcomes, and clarify personal values. They are designed to complement, rather than replace, counseling from a health practitioner.  When patients are given decision aids, such as educational booklets, videos, or interactive tools to help them make treatment choices, they are more knowledgeable and satisfied with their care. 

CLICK ON THE LINKS BELOW FOR PATIENT DECISION AID TOOLS

Coalition for Compassionate Care California
Tools are available for purchase.  

• Artificial Hydration Decision Aid (pdf)
• Tube Feeding Decision Aid (pdf)
• CPR Decision Aid (pdf) 
• Ventilator Decision Aid (pdf)
  
  

Intermountain Healthcare Decision Aids.  
Tools are available for free.
Intermountain Health's mission: helping people live the healthiest lives possible through quality, sustainable, and affordable care.  Intermountain Health is a United States not-for-profit healthcare system with 385 clinics and 33 hospitals in the Intermountain West. 

• Breathing Help Decision Aid (pdf)  
• CPR Help Decision Aid (pdf)
• Heart Failure Decision Aid (pdf)
• Tube Feeding Decision Aid (pdf)
  
  

The OPTIMISTIC Project Decision Aids.  
Tools are available for free. 
OPTIMISTIC was a grant funded project which ended in 2020. 

• CPR or No CPR:  What you should know (pdf)
• Tube Feeding: What you should know (pdf)
• Help with Breathing:  What you should know (pdf)
• Antibiotics:  What you should know (pdf)
  
  

Ottawa Hospital Research Institute – Decision Aids for Patients. 
Tools are available for free.
Ottawa Hospital Research Institute explores and shares better ways to help patients and clinicians make "tough" healthcare decisions that may have multiple options, uncertain outcomes, and benefits and harms that people value differently.  The website offers a wealth of information for practitioners including an A-Z decision aid search tool, an implementation tool kit, and training on “decision-coaching.”  https://decisionaid.ohri.ca/index.html

Respecting Choices  
Tools are available for purchase. 
Respecting Choices® is an internationally recognized, evidence-based model of advance care planning seeking to create a healthcare culture of person-centered care—care that honors an individual’s goals and values for current and future healthcare. 

• User Guide for Decision Aids
• Help with Breathing Decision Aid
• Cardiopulmonary Resuscitation (CPR) Decision Aid
• Long Term Tube Feeding