Advance Care Planning Tools & Resources List

A collection of useful advance care planning related tools and resources for healthcare providers and consumers.

Related Training And Information

Coalition for Compassionate Care of California Training/Curriculum
Widely used curricula supporting culturally congruent care (Building Bridges), Advance Care Planning, and Physician Orders for Life Sustaining Treatment (POLST).

CSU Institute for Palliative Care 
Effective Advance Care Planning: Skill Building for Everyone (online coursework series)
Advance Care Planning: A Guide for Health Care Professionals (Guide)

Prepare for Your Care
A web site designed to empower people to make decisions, talk with providers and get medical care that is right for them. Prepare for Your Care walks people through the basic steps in advance care planning and provides prompts and videos to help them get started.

Consumer Reports (Advance Care Planning)
Free, downloadable patient ACP booklet available in English and Spanish.

Respecting Choices
Evidence-informed training program and resources to promote person-centered care and ACP.

Caring Connections
Caring Connections is a program of the National Hospice and Palliative Care Organization (NHPCO) that provides free resources and information to help people make decisions about end-of-life care before a crisis. There are links to Advance Directives for all 50 states.

National Institute on Aging
General material, definitions and explanations for Advance Care Planning. Printable Wallet Card. Links to other resources.

American College of Physicians
Document on Advance Care Planning Implementation for Practices

American Bar Association
Tool kit and handouts for approaching and completing Advance Directives. Includes sections on “How to Choose an Agent” and “Starting the Conversation,” plus links to state specific Advance Directives.

Conversation Tools & Guides

Chinese American Coalition for Compassionate Care (Heart to Heart®)
Heart to Heart® cards are a bilingual (Chinese/English) communication activity designed to make it easier to understand what people might prefer when their lives are threatened by injury or disease.

Go Wish Cards
Go Wish cards from the Coda Alliance offer a non-threatening way to explore people’s preferences for care when seriously ill.

The Conversation Project
Stories for sharing, tools, and tips for initiating Advance Care Planning. The primary focus of the Conversation Project and their material is to help people overcome barriers to planning and to start talking to family and loved ones.

Advance Care Planning Conversation Guide
A guide from the Coalition for Compassionate Care of California

Ariadne Labs (Serious Illness Care)
Ariadne Labs consolidates evidence-supported videos, tools and resources to support decision making for the seriously ill.

BeginTheConversation.org
Learn how to take the first steps to begin the conversation. Work book and toolkit available. Information for community engagement and empowerment.

Common Practice (Hello/Gift of Grace)
The website has information on the evidence-based conversation game Hello (formerly Gift of Grace) to assist people in discussing what matters most to them.

American Society of Clinical Oncology (ASCO Answers: Advanced Cancer Care Planning)
A free downloadable decision-making guide for patients and families facing serious illness with information and resources about care options, communication tips and coping at end of life.

A Physician’s Guide to Talking About End-of-Life Care
Article: J Gen Intern Med. 2000 Mar; 15(3): 195–200.

A Culturally Responsive Approach to Advance Care Planning: A Reflection
Article: Managed Health Care Connect

Advance Care Planning Forms

Five Wishes Advance Directive
The nonprofit Aging with Dignity provides people with the practical information, advice and legal tools including the popular, low cost and easy to use Five Wishes Advance Directive.

Prepare for Your Care: Easy to Read Advance Directive

Giving Someone a Power of Attorney for Your Health Care: A Guide with an Easy-to-Use Legal Form for All Adults
Prepared by The Commission on Law and Aging, American Bar Association.

Basic Advance Care Planning Form

Advance Directive For Dementia
Available online, this resource offers a simple way to document medical care you would want if you had dementia. Developed by Barak Gaster, MD with help from experts in the fields of geriatrics, neurology, and palliative care.

California Physician Orders for Life-Sustaining Treatment (POLST) Form
Available in English and multiple translations.

National POLST (Physician Orders for Life-Sustaining Treatment) Paradigm
Information and patient resources on each state’s POLST efforts.

Videos

California Health Care Foundation: Advance Care Planning, Death & Dying
Five brief videos depict people as they reflect on their experiences with advance care planning, death and dying.

Dr. Angelo Volandes: ACP Decisions
ACP Decisions Tools and videos by Dr. Angelo Volandes

Billing For Advance Care Planning

Billing for Advance Care Planning Conversations
Web-based training for health providers presented by CSU Institute for Palliative Care and the Coalition for Compassionate Care of California.

Guide to Medicare Advance Care Planning Codes
Medicare Learning Network

2016 Medicare Physician Fee Schedule, Final Rule
Medicare Physician Fee Schedule policy governing ACP services, Pages 70955–70959

Billing for Advance Care Planning – FAQs
Coalition for Compassionate Care of California

Research/Reports/Studies

Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life
2014 Institute of Medicine consensus report on end-of-life care in the United States

Dying in California: A Status Report on End-of-Life Care in California
California Health Care Foundation

Conversation Starters: Research Insights from Clinicians and Patients on Conversations About End-of-Life Care and Wishes
John A. Hartford Foundation, Cambia Health Foundation and California Health Care Foundation.

Conversation Stopper: What’s Preventing Physicians from Talking with Patients about End-of-Life and Advance Care Planning?
John A. Hartford Foundation, Cambia Health Foundation and California Health Care Foundation.

Final Chapter: Californians’ Attitudes and Experiences with Death and Dying (2012)
Lake Research Partners and the Coalition for Compassionate Care of California

Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. JAMA Intern Med.2014;174(12):1994-2003. doi:10.1001/jamainternmed.2014.5271