Table 2.

An Example of Epic Advance Care Planning Checklist SmartPhrase, Adapted from the Serious Illness Care Conversation by Ariadne Labs12

Serious Illness Care Plan (.famacp)
1. Set up the conversation“I'd like to talk about what is ahead with your illness and do some thinking in advance about what is important to you so that I can make sure we provide you with the care you want — is this okay?” (The patient must give permission for this discussion, per Medicare guidelines. They can decline to discuss.)
    *Introduce purpose
    *Prepare for future decisions
    *Ask permission
2. Assess understanding and preferences“What is your understanding now of where you are with your illness?”
“How much information about what is likely to be ahead with your illness would you like from me?”
3. Share concerns about the future
    *Frame as a “wish … worry”, “hope … worry” statement
    *Allow silence, explore emotion
“I want to share with you my understanding of where things are with your illness …”
Uncertain: “It can be difficult to predict what will happen with your illness. I hope you will continue to live well for a long time but I'm worried that you could get sick quickly, and I think it is important to prepare for that possibility.”
    Function: “I hope that this is not the case, but I'm worried that this may be as strong as you will feel, and things are likely to get more difficult.”
    Time: “I wish we were not in this situation, but I am worried that time may be as short as ____ (express as a range, e.g., days to weeks, weeks to months, months to a year).”
4. Explore key topics“What are your most important goals if your health situation worsens?”
    *Goals“What are you biggest fears and worries about the future with your health?”
    *Fears and worries“What gives you strength as you think about the future with your illness?”
    *Sources of strength“What abilities are so critical to your life that you can't imagine living without them?”
    *Critical abilities“If you become sicker, how much are you willing to go through for the possibility of gaining more time?”
    *Tradeoffs“How much does your family know about your priorities and wishes?”
“Do you want to make it more concrete?” Consider IPOST.
5. Close the conversation
    *Make a recommendation
    *Check in with patient
    *Affirm commitment
“I've heard you say that ____ is really important to you. Keeping that in mind, and what we know about your illness, I recommend that we ____. This will help us make sure that your treatment plans reflect what's important to you.”
“How does this plan seem to you?”
“I will do everything I can to help you through this.”
6. Document your conversation
7. Communicate with key clinicians
  • IPOST, Iowa Physicians Orders for Scope of Treatment.

  • Statement of Patient Consent and Time Spent on Advance Care Planning: [Patient name] voluntarily consented to an advance care planning discussion to aid in considering and prioritizing their treatment goals. I spent *** minutes face-to-face with [patient's name] and [add any other participants (family, RN, MA, etc.) discussing Advance Care Planning.