Advance Care Planning : Five Promises of Advance Planning : Initiate conversations

This promise involves much more that meeting the requirements of the PSDA. More needs to be asked than a simple question on admission about the existence of an advance directive. The promise involves a commitment to initiating skillful conversation in timely and appropriate means, stressing the importance of early discussion in outpatient and community settings. It includes educating professionals in the necessary facilitation skills to produce satisfying conversations and individualizing the content of these conversations to the unique needs and circumstances of the individual. The word "initiate" is critical as it emphasizes the beginning of a process that will require further conversations.

In evaluating whether an organization or community Advance Care Planning Program is meeting this promise, the following questions could be asked:

• Who are advance care planning conversations being initiated with? All adults? Adults with progressive diseases? Adults who we would not be surprised if they died in the next 12 months? Patients with new, serious medical problems, such as a heart attack or stroke, who have not considered advance care planning?
• Where are these conversations occuring? In the clinic or ambulatory setting? In the hospital? Pre-institution e.g workshops, attorney offices?
• Who is intiating these conversations? All health professionals? Only trained health professionals? Non-professionals? Physicians?

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