Background Emergent situations and settings actively present a unique range of barriers to meaningful conversations about treatment preferences that can derail authentic shared decision making processes in the context of advanced care planning.

Aims Aim 1: Identify parameters/dimensions and conditions that support high quality advanced care planning decision making processes.

Aim 2: Describe language choices that facilitate/constrain healthcare providers achieving a shared understanding of care needs and optimal advance care planning.

Methods This study uses observational and recorded data from interactions between patients, their caregivers and health care providers within a local Emergency Department to examine specific patterns of participant language use that ensure mutually productive and sustainable patient-family-provider advanced care planning conversations.

Results Preliminary results indicate interactional opportunities for creating and sustaining effective advanced care planning conversations as a process at hospital admission, during clinical deterioration, and following transfer to hospice, a nursing home or the ICU.

Discussion and conclusion Emergent settings force healthcare professionals to reconceptualize advanced care planning conversations as living, evolving processes. Doing so provides interactional partners with multiple opportunities to negotiate and overcome barriers to shared decision making in emergent settings. Focused communication and decision-making guides as well as specific education in interaction design for advanced care planning conversations can advance the efficiency and effectiveness of decision making processes in emergent settings and establish quality standards for clinician-patient communication, in the advance care planning context.