Advance Health Care Planning
Everything you need to know about the advance care planning process, which involves thinking through the kind of care you would want to receive if you were unable to make healthcare decisions for yourself.
What is advance health care planning?
Advance health care planning helps you plan the health care you would want to receive if you became too ill to make decisions for yourself.
In advance care planning, you start by thinking about:
- What matters most to you in life
- What gives you meaning
- Who you would like to make decisions for you
- Health care you would or wouldn't want
Some people want to receive all possible medical treatments, no matter what. Others want to receive medical treatments only if there is a chance they will get better with them. These are your decisions to make. They are based on your values, preferences, and discussions with your loved ones.
A big piece of advance care planning is completing an Advance Health Care Directive. This is a legal form that contains all the information about what kind of care you would want, if you were to become very ill. It can be completed by anyone 18 years of age or older.
An advance health care directive is something that you can change over time, as your health and life changes. You can make these changes at any time.
Why think about this kind of health care planning now?
"It's always too early, until it's too late." People often think it's too early to start advance care planning, and that they don't need it "just yet." However, no one plans to get seriously sick, or to get into an accident. But, if these things happen and you do not have an advance care plan in place, it may be too late for you to let people know the kind of care you want. That's why it's important to be ready now for whatever may come. Health care teams see how hard it can be for your loved ones to make decisions for you, when they aren't really sure what you would want.
Advance care planning is not just for serious illness. Everyone should have advance care planning done.
-Josh Fronk, DO
How do I get started?
It’s normal to feel nervous about starting this process. The good news is there are some clear steps you can take to get started. Keep in mind, advance care planning is something you do over time. You can always come back to your advance health care directive and change it.
1. Talk with your doctor about your current health
It is important to know what all your health conditions are now, and how these conditions could change over time. You will need to talk with your doctor to understand these things. Once you know where you are now, it will help you think more clearly about the future.
2. Think about what matters most to you
Think about your hopes and goals in life. Think about the things you like to do or experience that give you joy and meaning in your life. You may want to think about what fears or worries you have about the future. It's okay to not know exactly what matters most to you, and it could change over time.
3. Choose a surrogate decision maker (A surrogate is someone who could make decisions for you if you were unable to do so)
Think about the person you would like to be your decision maker. While your loved ones can make decisions together for you if they're all in agreement, one person will still need to be selected to make the final decision if there are differences in opinion.
A good decision maker is someone who:
- You can trust to make the decisions you ask them to make. Sometimes it can be hard for our loved ones to make the decisions we want. Finding someone who can follow your wishes is important.
- You can explain your values to, and what matters most to you, and they will listen and understand them. You can talk to this person over time, and let them know if your decisions have changed.
- Will be able and willing to speak up and voice your thoughts and feelings to the healthcare team
- Is willing to play this role. A decision maker does not need to live in your same city or state, but does need to be able to communicate with your healthcare team when they are needed
4. Complete an Advance Health Care Directive
There are a number of Advance Health Care Directive forms that are valid in California, and here are a couple of our favorites:
- Stanford Letter Project - provides steps to go through to think about what matters most. It uses letter writing to think through these things. After going through these steps, you will have a completed advance health care directive.
- PREPARE For Your Care -an online step-by-step program to complete an advance health care directive, that is easy to understand. It providesvideos of people thinking through their decisions at each step of the process. This website allows you to choose the advance health care directive that is required in your state, and it provides them in multiple languages. Click to download these PREPARE advance health care directives on the right side of this page.
Download California advance health care directives (AHCDs)
If you are a patient at Stanford
Frequently Asked Questions
The Coalition of Compassionate Care of California has a useful "FAQ" page about advance care planning here. This coalition provides information and resources for anyone who is seriously ill or near the end of life.
How can palliative care help with advance care planning?
Palliative care teams are very skilled at helping people advance care plan. They can take time to talk to you about this process and:
- Help you identify what matters most to you and what having a quality of life looks like for you
- Help you discuss your care wishes with your loved ones in a meeting, called "family meetings." Palliative care teams have a lot of skill in working through the emotions and questions that can come up when you talk with your loved ones.
- Communicate with your other doctors and health care teams about your advance care plan and your wishes
- Help you to put your wishes in writing in the advance health care directive
Guides for talking to your loved ones
- American Bar Association -- offers a toolkit for health care advance planning
- Caring Info --provides multiple resources about advance care planning, palliative care, and hospice. This site provides resources in English, Spanish, and Mandarin
- Defining Hope --a documentary feature about people weighing what matters most at a critical time
- Go Wish --a card game available to order that is an easy, entertaining way to talk about what matters most. Developed in San Jose, CA.
- Prepare for Your Care- Offers advance health care planning resources and downloadable advance directives from multiple states
- The American Cancer Society website includes information about advance directives
- The Conversation Project--provides guidance about advance care planning, and how to talk to your doctors and loved ones about the care you would want if you were to become seriously ill
Above resources taken from the Hospital and Palliative Nurses Association website
Advance health care directive and POLST forms:
You can find different versions of advance health care directives in the links below:
- Advance Directive for Dementia --an advance health care directive addressing the specific and unique needs of people with dementia
- Five Wishes --an easy-to-use legal advance health care directive document available in a variety of languages.
- My Directives --offers both online and mobile app options for completing advance directives
- National Physician Orders for Life Sustaining Treatment (POLST ) Paradigm --provides materials for planning and completing a POLST with your physician.
- Prepare for Your Care- Offers advance health care planning resources and downloadable advance directives from multiple states
Virtual advance care planning workshops
Stanford's 2 Part Virtual Advance Care Planning Workshops- Our Palliative Care Health Education, Engagement, and Promotion program is delivering 2 -part ACP workshops every 3 months!
Hospice Giving Foundation- Provides regular, free virtual 45 minute advance care planning workshops. Also provides workshops on the POLST, on starting advance care planning conversations, and on understanding medical decisions like palliative care, CPR, and ventilators. Click here to register.
UCSF MERI Center for Education in Palliative Care at Mt. Zion - Providing free virtual monthly 2 part advance care planning workshops. Those who attend both parts will receive a free book and Go Wish cards! Click here to register.