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Table 1 The ACP workbook's 12 open-ended questions

From: Using a self-directed workbook to support advance care planning with long term care home residents

Step

ACP Stage

Open-ended questions

1

Precontemplation

What do you need to do before you feel ready to have the conversation?

Do you have any particular concerns that you want to be sure to talk about?

2

Contemplation

What matters to me through the end-of-life is…

What kind of role do you want to have in the decision-making process?

What do you notice about the kind of care you want to receive?

What role do you want your loved ones to play?

What do you feel are the three most important things that you want your friends, family, and/or health care team to understand about your wishes and preferences for end-of-life care?

3

Preparation

What do you want to be sure to say?

4

Reflection on Conversations

Is there something you need to clarify that you feel was misunderstood or misinterpreted?

Who do you want to talk to next time? Are there people who should hear things at the same time?

How did this conversation make you feel? What do you want you/your loved ones to remember?

What do you want to make sure to ask or talk about next time?