What You’ll Learn

  1. Elicit permission to begin conversations about advance care planning with the patient and their family
  2. Define the goals of advance care planning conversations for the patient
  3. Position advance care planning in the future, and distinguish it from present decision-making
  4. Recognize that advance care planning conversations inform your understanding of the patient’s values and allow you to explore the future with the patient in a non-threatening way

What You’ll Earn

Only CAPC members who are logged in can earn the following free Continuing Education Credits:

  • 0.50 AMA PRA Category 1 Credit(s)™
  • Nursing: 1.00 CNE
  • Social Work: 1.00 CE (NYSED)
  • Social Work: 1.00 CE (NASW)

To take this course, log in. Or, check here to see if your organization is a member.

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Complete evaluation

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Tools & Resources

Advance Care Planning Conversations: Key Takeaways
MEMBERS ONLY locked

Stepwise approach to discussing advance care planning with patients or surrogates. Center to Advance Palliative Care and VitalTalk.

Billing and Coding for Advance Care Planning (ACP) Services
MEMBERS ONLY locked

Requirements, best practices, documentation requirements, and time thresholds for Advance Care Planning (ACP) services. Center to Advance Palliative Care, 2018.

Billing the Physician Fee Schedule for Advance Care Planning Services
MEMBERS ONLY locked

One-page reference guide to billing for advance care planning conversations. Center to Advance Palliative Care and Acevedo Consulting, August 2016.

Goals of Care Conversation: Role Play

In this video, Kacey Boyle, RN, MSPC, leads us through an example of a goals of care conversation between a clinician and a patient.

Optimizing Billing Practices

Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.

Conversation Script: Goals of Care

This conversation script provides skills and techniques for conducting goals of care conversations with patients, regardless of the existing clinician-patient relationship.

Talking to Patients About Hospice: Role Play

In this video, Jonathan Fisher, MD, leads us through a mock conversation between a patient whose illness has progressed, and a clinician who explains the benefits of hospice care.

Conversation Script: Talking to Patients About Hospice

This communication script provides techniques for clinicians to foster meaningful conversations about hospice.

VitalTalk - Quick Guides

One-page guides with actionable tips for conversations with patients with serious illness. Free to download, print and share with others.

POLST Training Videos

Brief videos to help clinicians hold appropriate conversations with patients about the completion of the POLST form (Physician Orders for Life Sustaining Treatment).

Empathetic Responses Guide
MEMBERS ONLY locked

This resource provides practical samples of empathic responses to use in conversations with patients and families, as well as template responses to challenging questions. Developed by VitalTalk.

Key Takeaways for Care Managers: Advance Care Planning Conversations
MEMBERS ONLY locked

A list of advance care planning conversation tips for care managers.

Sample Script and Guidance: Cold-Calling Patients to Initiate Advance Care Planning
MEMBERS ONLY locked

This script for care managers provides guidance and sample language to use when calling without a prior relationship to begin advance care planning for patients with serious illness.

Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN. Consultant, Center to Advance Palliative Care.

Andrew E. Esch, MD, MBA. Consultant, Center to Advance Palliative Care.

Lynn Hallarman, MD. Associate Professor of Medicine, Director of Palliative Medicine, Stony Brook University Hospital.

Jaime Goldberg, MSW, LCSW, ACHP-SW. PhD student, University of Wisconsin-Madison School of Social Work.

Philip Higgins, PhD, LICSW. President, Lighthouse Counseling of Salem, Inc.

Lynn Hill Spragens, MBA. President and CEO Spragens & Associates, LLC.

Jay R. Horton, PhD, ACHPN, FNP-BC, MPH, CENP. Director of Nursing Safety, Quality, and Performance Improvement Mount Sinai Hospital. Assistant Professor Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai.

Khadidjatou Kane, MD. Oncology Hospitalist, Assistant Professor of Hospital Medicine, Northwestern University Feinberg School of Medicine.

Lolita Melhado, MSN, ARNP, FNP-BC. Family Nurse Practitioner/Palliative Care, Gulf Coast Medical Center - Lee Memorial Health System.

Bridget Montana, MSN, APRN, FPCN, MBA. Hope HealthCare Services, Chief Operating Officer.

Colleen Mulkerin, MSW, LCSW. Director Palliative Care Consult Service, Hartford Hospital.

Drew Rosielle, MD, FAAHPM. Palliative Care, Fairview Health Services, University of Minnesota Medical School.

David Weissman, MD. President, Palliative Care Education, LLC.

Amy Case, MD, FAAHPM. Associate Professor of Oncology, Chair, Department of Supportive Care.*

Melissa Bakar, MD. Assistant Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai.*

Elizabeth Mann, MD. Fellow, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai.

*indicates ABIM Peer Reviewer

Contact information: For answers to frequently asked questions about CAPC courses, read the Online Course FAQ. For technical questions about course activity, email [email protected]. For questions about continuing education credits, contact 201-957-0077.

Provided by the Icahn School of Medicine at Mount Sinai.

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