Article Text

Download PDFPDF

Catalysts for conversations: practical experience of advance care planning in the USA
Patient-Centered Worksheets for Advance Care Planning: Education for Patients and Guidance for Clinician Communication
  1. R Pearlman
  1. National Center for Ethics in Health Care (VHA)


In the 1990s the Veterans Health Administration (VHA) developed worksheets to help patients think about and discuss aspects of advance care planning (ACP). The content of the worksheets was based on input from patients, family members, physicians, and religious leaders. Research demonstrated that the worksheets improved clinician understanding of patient values and preferences. The worksheets were updated in 2008–2009 with input from experts, including clinicians, religious leaders, ethicists, and attorneys. This was followed by an iterative content review involving subject matter experts and senior VHA leaders, and editing by experts in patient education and communication.

The worksheets elicit a patient's values and/or preferences, such as hopes and fears (eg, ‘If I have a condition that will make me die very soon, even with life-sustaining treatments …, what would be your biggest fears … ? What would you most want to avoid?’), strongly held beliefs (eg, ‘I gain strength from other things like family, prayer, inspirational literature, or music. I want the following things included [in] my care: … ‘), contacts for taking care of important things, mental health care, conditions in which life-sustaining treatment would be wanted (versus not wanted), and care during one's last days.

Workshop participants will assign priorities to aspects of ACP they wish to discuss, discuss their approaches to a priority aspect of ACP, complete a worksheet on the same subject, and then discuss the strengths and weakness of the worksheet for their practice. This will be repeated for several worksheets to demonstrate their applications and value in ACP.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.