Table 1.

Communication Modalities Used in Serious Illness: Aims and Comparisons with Advance Care Planning.

Intervention	Aim	Similarities with ACP	Differences from ACP
Advance Directives: “Written documents (often called living wills) that provide instructions or name a surrogate decision maker (often called health care proxy or durable power of attorney [DPOA] for healthcare), are one legal method by which patients may state preferences in advance of a period of incompetence.”94	⦁ Legal document assisting in patient self-determination, creating the opportunity to name a legal surrogate decision maker and provide detail about what kinds of goals, values, wishes, and preferences one has	⦁ Aim to provide a tool whereby people can achieve medical care that aligns with their wishes, aimed for any stage of health for adults	⦁ It is a legal document (rather than a communication intervention)
Discussions About Core-Health Related Values: Discussions that support patients in articulating values as a premise for medical-decision making.8	⦁ Ideally to support patients when clinically stable to discuss values related to their identity and dignity; affirms personhood; may assist with planning treatment options	⦁ One component of ACP focused on elicitation of individual values that may assist patient or surrogate decision-making in current or future settings	⦁ Not provided with the intent of making preferences for medical decision-making known, but rather fostering trust and rapport as a component of quality serious illness care
Shared Decision-Making: “An approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences.”95	⦁ To confer agency and independence in making medical decisions by helping individuals to make their own free, informed decisions	⦁ Described processes anchor on what matters most to patients	⦁ For active and in-the-moment choices
Serious Illness Conversations: Iterative discussions between clinicians and patients/caregivers about goals, values, preferences, and prognosis in the context of advancing serious illness or illnesses.96	⦁ Clinician/patient processing of advancing serious illness (building prognostic awareness) and discussion of what matters most in that context	⦁ Iterative process; preparing for later decision-making; focusing on what matters most, not about filling out forms	⦁ Not specifically about current/future medical decision-making or aligning medical care with wishes; targets patients with one or more serious illnesses and thus limited life span; addresses illness(es) most affecting their lives
Prognostic Discussions: Ongoing discussions between clinicians and patients/caregivers to describe and clarify understanding of prognosis, disease awareness, and relevant implications.97,98	⦁ A component of serious illness conversations (as above); clinician/patient discussion to foster disease awareness tailored to patient’s desired amount of information; may assist with clarifying goals, values, and preferences	⦁ Ongoing process to be revisited with transitions in care, decision points, and changes in disease status and prognosis	⦁ Not aimed at eliciting goals, values, and preferences although this may be a potential outcome
Goals of Care (GOC) Conversations: Discussions of GOC, which can be defined as “the overarching aims of medical care for a patient that are informed by patients’ underlying values and priorities, established within the existing clinical context, and used to guide decisions about the use of or limitation(s) on specific medical interventions;”99,100 can be approached as early and late GOC conversations.	⦁ To discuss and delineate the aims of, and thus make decisions about, medical care based on what matters most to patients, focusing on the current clinical context ⦁ For early conversations, could include preparing for an impending decision (i.e., next line of cancer treatment); for later conversations, making decisions about end-of-life care (i.e., application of non-invasive positive pressure ventilation)	⦁ Focuses on what matters most, also not specifically about completing forms	⦁ Aimed toward more “in-the-moment” medical decisions for patients with active health issues and illnesses
Medical Orders for Life Sustaining Treatments (MOLST): In some settings called Physician Orders for Life Sustaining Treatment (POLST); forms that augment traditional methods for advance care planning by translating treatment preferences into medical orders, including for cardiopulmonary resuscitation (CPR), scope of treatment, artificial nutrition and/or hydration, and in some states, antibiotic use;”101 a legal order form listing individual treatments; varies by state	⦁ To record individual treatment choices on a legal, transferrable order form to honor preferences across settings	⦁ Created for noting preferred medical treatment choices; aims for goal-concordant care	⦁ Legal document (rather than a conversation), actionable and clinician-signed order set, limited to individual treatment choices
Code Status Discussions: “Conversations eliciting patient preferences about cardiopulmonary resuscitation (CPR)”99 and intubation along with benefits, risks, likely outcomes, and alternative options	⦁ A shared decision-making conversation where patients make choices about whether they would want CPR, in the event of cardiopulmonary arrest, with an aim of placing a code status order reflecting the patient’s self-determined choice	⦁ Aim is to make a medical decision to honor patient’s autonomous wish	⦁ Not by definition anchored in what matters most to patients; about a single medical decision that pertains to a cardiopulmonary arrest and the decision to intubate ⦁ Often a compulsory component during hospitalizations