Assessing the patient's readiness for ACP Conversations

If the patient has never heard of ACP or is not interested, the first conversation may focus on explaining ACP, how it may be beneficial and how it can impact future care.

If a patient is accepting of ACP, a pamphlet explaining the elements can be provided.

If the patient is not yet ready to consider discussing ACP, it may still be an opportunity to discuss his or her SDM(s).

Stage

What the patient knows or is doing about ACP

Pre-contemplative

Patient does not know about or has considered ACP

Contemplative

Patient may be aware of ACP but not ready to take action

Planning

Patient reviews ACP educational materials or discusses the topic of ACP

Action

Patient knows who their SDM(s) is, has discussed wished, values and beliefs with SDM(s) and may request help for further clinical information

Maintenance

Willing to revisit ACP conversation with SDM(s)

 

 

Stage

Advice to clinician

Pre-contemplative

 Introduce ACP and provide educational material if patient seems open
 Indicate questions or concerns about ACP can be addressed in future visits

Contemplative

Ask if they have questions or need further information about ACP as well as their current health circumstances. Offer resources that would assist identifying values or wishes. Talk about the role and importance of SDM.

Planning

Engage in discussion regarding ACP educational materials. Discuss automatic SDM(s), Attorney for Personal Care if necessary and alternate in case SDM(s) unwilling or unable to assume duties.

Action

Meet with patient and the SDM(s) to facilitate ACP conversation

Maintenance

Periodically review and discuss ACP particularly with a change in health status or with critical illness or EOL of family member or friend
Adapted from:
1. Westley C & Briggs L. Using the Stages of Change Model to Improve Communication About Advance Care Planning. Nursing Forum 2004. 39(3).