Table 3.

Suggestions for ‘normalizing’ ACP among Albertans

Theme	Supporting comments
Education
• Educate the general public	“education of public where to access materials and how to use them”
• Educate youth/young adults	“this should be discussed in high school … to become a natural thing to look at”
• Educate professionals (e.g. healthcare, legal, financial professionals)	“Train all helping professionals in their university training about Advanced Care Planning but also trained in how to have the conversations - > skill needed”
• Educate community organizations	“holding sessions through community groups, churches, etc. to educate and having someone there to answer questions”
• Educate through conferences, health fairs	“Pushing concept at conferences- e.g. retired teachers”
	“health fairs- hand out pamphlets”
• Educate through employers	“workshops offered by companies for employees”
Integrate into life events	“Revisit PD at marriage, kids, divorce, disease, losing a family member”
• Driver’s license, marriage, birth of child, divorce, new medical diagnosis, retirement, will/estate planning, funeral planning/death of loved one
	“Part of annual visit with GP”
	“driver’s license or health care card - have you signed a personal directive - tick box”
Introduce ACP earlier in life	“start this conversation with people when they are young”
Standardize terminology across the country	“GCD & DNR, common language in the country”
Mandate ACP	“mandate primary care networks to have conversations”
	“long term care/assisted living facilities could insist on having this for all residents”
Change focus toward quality of life, not just end of life	“frame as planning for life not planning for death”
Provide incentives (for public and professionals)	“extra lines (directives) on financial and investment and mortgage papers and life insurance policies 'personal directive discount”
• Financial, emotional
	“change GP billing codes”
	“Educate what happens when you don’t have a PD - give the negatives of the story”
Advertise ACP	“need to advertise, let people know to normalize the activity”
• Web, social media, television, print media, annual events (e.g. National ACP Day, fun run), public awareness campaign	“put on facebook, social media for younger generation”
	“Terry Fox run, incorporate death and dying”
Make ACP accessible to different cultures	“cultural community and group education”
	“cultural training/sensitivity to ACP”
	“language translation is needed for other groups”
Share stories	“peer-to-peer stories help having experienced it already”

DNR do not resuscitate, GCD goals of care designation(s), GP general practitioner, PD personal directive