Table 3 Content categories and illustrative paper-based ACP aid excerpts

1. ACP definitions

“Advance care planning is a step-by-step process to help you plan for medical decisions in your future.” (4)

“Advance care planning is the ongoing process of discussing values and goals of care, determining and/or executing treatment directives and appointing someone to speak for you when you cannot speak for yourself.” (5)

2. Values clarification

“What matters to me is ________. Start by thinking about what’s most important to you. What do you value most? What can you not imagine living without?” (1)

“What do you most value about your physical or mental well-being? For example, do you most love to be outdoors? To be able to read or listen to music? To be aware of your surroundings and who is with you?” (2)

3. ACP conversations

“Perhaps the single most important step in ACP is talking about your wishes with whom might be called upon to speak for you. There is no ‘right way’ to start this conversation. Nor is there a ‘right’ time. The best thing to do is make time and get started.” (3)

“There are many events and openings that can help you get started [with the conversation].Conversation triggers include: the death of a friend or colleague; newspaper articles about illness and funerals; movies, sermons…” (12)

4. Decision-maker selection

“On a scale from ‘I want my loved ones to do exactly what I’ve said’ to ‘I want my loved ones to do what brings them peace even if it goes against what I’ve said’, how involved do you want your loved ones to be?” (1)

“Picking the right person to be your health care agent. Choose someone who knows you very well, cares about you, and who can make difficult decisions…” (9)

5. Survival odds or statistics

“Would you be willing to endure severe side effects if the chance that you would regain your current health was: high [over 80%]; moderate [50%]; low [20%]; very low [less than 2%]; very, very low [less than 1 in 1000]” (2)

“CPR Pros & Cons. Pros: CPR can save lives, especially when it’s given to a young, healthy person right after cardiac arrest….Cons: CPR is often unsuccessful, especially when it’s given to someone who has a very serious or incurable disease. Most hospitalized patients who get CPR don’t survive to leave the hospital….” (4)

6. Form descriptions

“Through a legal document known as a Durable Power of Attorney for Healthcare Decisions, you can designate a person to make health care decisions on your behalf should the need arise.” (7)

“The Medical Directive allows you to record your wishes regarding various types of medical treatments in several representative situations so that your desires can be respected.” (10)