How should advance care planning conversations be initiated with older adults or patients with chronic illness?

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Begin with the idea that advance care planning should start early and be revisited over time. Have conversations in plain, clear language and center them on what matters most to the patient—their goals, values, and what they understand about their illness and options. Involve family members or caregivers as appropriate to support shared decision-making and to have a trusted advocate if decisions need to be made. This ongoing, patient-centered approach helps ensure that care plans align with the individual’s preferences across the illness trajectory, reduces the likelihood of unwanted or burdensome treatments, and provides clear guidance for future decisions. Start discussions when the person is relatively stable, explain prognosis and choices honestly, and document preferences in an advance directive or appoint a surrogate, updating these if circumstances change.