Table 2.

Examples of Suggested Adaptations by Theme

	Brazil	Australia
Linguistic	- suggestion to substitute ‘honor your wishes’ by ‘consider your wishes’ (more colloquial tone)	- differences in most commonly-used term e.g., tracheotomy vs. tracheostomy (adjusted to the correct terminology in Australian English) - suggestion to substitute ‘what gives me joy’ by ‘what makes me happy’ (more colloquial tone)
Cultural	- rewording ‘When my end-of-life is near” to “When the moment that the end of my life is near arrives” (less direct approach to end-of-life care) - remove references to ‘memorial services’ and ‘celebration of life’ (not relevant to Brazilian culture)	- rewording elements of the section on ‘Religious/spiritual beliefs’ e.g., remove references to ‘asking/giving forgiveness’ (due to considerations that this may either be confronting, confusing or irrelevant for a more secular Australian AYA population) - expand options for different religious figures in the section on the section on ‘Religious/spiritual beliefs’ (e.g., including ‘Imam’ for Muslim patients) (to account for a more diverse and different range of religious/cultural communities in Australia)
Health system	- remove references to ‘Medicaid’ (not relevant to Brazilian health system) - differences in the definition of “benefits” (adjusted to the Brazilian health system context)	- remove references to ‘Medicaid’, or ‘hiring or firing health care providers’ (not relevant to Australian public health system)
Legal	- keep information about emergency care, but remove direct reference to the ‘Do Not Resuscitate order’ (not relevant to Brazilian health system)	- include prompts to consider formalized/legal clinical processes and documentation in the Australian setting to ensure that the young person’s decision is legally-binding and actually acted upon (such as ‘not for resuscitation’ or ‘NFR’ forms, “No CPR” orders and ambulance plans, as well as a legal will) (to enhance utility within Australian healthcare system)