Advance Serious Illness Planning Resources

The additional resources listed below can help you think more about your values and preferences and provide you with more information about medical treatments and medical decision-making.

Advance Serious Illness Planning on Paper

Available in French and English, for individual use and for ordering in bulk from print shops. 

The last 4 pages serve as the Dear Doctor Letter.

Explainer Videos

Available videos:

  • CPR Decision Aid
  • Advance Care Planning Conversations
  • Deciding on a Representative (substitute decision maker)
  • Being a Representative (substitute decision maker) 
  • What if you were hit by a bus?
Bilingual CPR Videos

Cardiopulmonary resuscitation: let’s be ready to talk about it!

La réanimation cardiorespiratoire : soyons prêts à en parler!

Caregivers Resources

Much focus and attention is given to patients, rightfully so, however caregivers play an integral role in an illness journey. These resources have been compiled to offer supports and tools to empower a caregiver in their important role.

Free Caregivers Guide

Inspired by our own caregiving journey, we’ve created this free handbook to help you be more prepared for the task at hand, feel more yourself, and reduce your stress. We have also included 15+ worksheets and resource lists to give you the essential tools to support you in your role as caregiver.

Included in the guide:

  • how to define your role and set boundaries
  • list of Canadian financial supports for caregivers
  • 5 tips for asking for help
  • the caregiver’s hospital survival kit
  • loved one’s needs assessment

+ many more tools and resources to help you along the way.

Plan Well Publications

Dr. Daren Heyland and colleagues have been scientifically validating the Plan Well system in clinical settings for over 20 years. The Guides you see today are the culmination of those years of research. To read more about how we got here and how our Guide was developed, feel free to browse through our publications:

We published an article in the journal Health Expectations detailing the process of English to French translation and cultural adaptation of the Plan Well Guide.

Randomised trial of a serious illness decision aid (Plan Well Guide) for patients and their Representatives to improve engagement in advance care planning.

In a post-hoc subgroup analysis, there was a significant difference in favour of the Plan Well Guide group in participants with a lower-than-median baseline score compared with those at or above the median. The use of Plan Well Guide led to a significant improvement among Representative (formerly called Substitute Decision Makers) who were the least prepared at the start.

A randomized trial of Plan Well Guide was recently published in CMAJ Open. The results showed that Plan Well Guide improves decision quality, patient and physician satisfaction, and reduces time physicians spend on their interactions with patients.

The Health Education Journal recently published findings from the Preparedness for the Future survey. The purpose of this paper is to describe people’s general state of preparedness for their future as older persons, identify specific attitudes towards ageing and key characteristics that portend a lesser degree of preparedness, and identify the issues that need greater emphasis. The findings show that people’s attitudes towards their future self as an older person are related to their state of future preparedness and may have an impact on their future health and well-being.

Articles by Year

March 25

Journal of Palliative Medicine: Caught in a Loop with Advance Care Planning and Advance Directives: How to Move Forward?  Experts in advance care planning discuss the problems associated with traditional advance care planning and deliberate embracing our new approach ‘advance serious illness planning’!

November 25

Patient Education and Counseling, Volume 104 – Issue 4: Effect of “Speak Up” educational tools to engage patients in advance care planning in outpatient healthcare settings: A prospective before-after study

September 23

MedRxiv Preprint: Supporting decision-making on allocation of ICU beds and ventilators in pandemics

September 17

ICU Management & Practice, Volume 20 – Issue 3: Unmasking the Triumphs, Tragedies, and Opportunities of the COVID-19 Pandemic

September 1

Australian Critical Care, Volume 33 – Issue 5: Shared decision-making in the intensive care unit requires more frequent and high-quality communication: A research critique

August 11

The Royal College of Physicians and Surgeons of Canada: New tool helps patients plan for serious illness care

July 18 

Healthcare, MDPI, Volume 8 – Issue 3: Advance Care Planning (ACP) vs. Advance Serious Illness Preparations and Planning (ASIPP)

July 10

Ontario Hospital Association: Supporting Patients in Getting the Medical Care that Is Right for Them

June 3

Canadian Geriatrics Journal, Volume 23 – Number 2: The Impact of Prior Advance Care Planning Documentation on End-of-Life Care Provision in Long-Term Care

June 1

Canadian Medical Protective Association Practically Speaking Podcast: COVID-19: Advance care directives

May 25

BMC Family Practice, Volume 21- Number 94: Exploring patient-reported barriers to advance care planning in family practice

May 21

Canadian Hospice Palliative Care Association: Become a CHPCA Associate or Affiliate / Provincial Member

May 1

Canadian Geriatrics Journal, Volume 23 – Issue 2: The Impact of Prior Advance Care Planning Documentation on End-of-Life Care Provision in Long-Term Care

Journal of Post-Acute and Long-term Care Medicine, Volume 21 – Issue 5: A Multicenter Study to Identify Clinician Barriers to Participating in Goals of Care Discussions in Long-Term Care

April 28

Canadian Medical Association Journal, Volume 8 – Issue 2: A novel decision aid to help plan for serious illness: a multisite randomized trial

March 2020

The Annals of Family Medicine, Volume 18 – Issue 2: Effect of an Interactive Website to Engage Patients in Advance Care Planning in Outpatient Settings

March 25

Family Practice, Volume 37 – Issue 2: Primary care clinicians’ confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey

January 19

The Lancet: EClinicalMedicine, Volume 19: Advance care planning; we need to do it more, but it needs to be done differently

February 1, 2018

Journal of Pain and Symptom Management, Volume 55 – Issue 2: Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus 

January 1, 2018

Journal of Pain and Symptom Management, Volume 55 – Issue 1: Development and Psychometric Properties of a Survey to Assess Barriers to Implementing Advance Care Planning in Primary Care

December 6, 2017 

BMC Medical Informatics and Decision Making, Volume 17 – Number 164: Recognizing difficult trade-offs: values and treatment preferences for end-of-life care in a multi-site survey of adult patients in family practices

November 1, 2017

Journal of Cardiac Failure, Volume 23 – Issue 11: Barriers to Goals of Care Discussions With Patients Who Have Advanced Heart Failure: Results of a Multicenter Survey of Hospital-Based Cardiology Clinicians

September 1, 2017

BMJ Supportive & Palliative Care: Discordance between patients’ stated values and treatment preferences for end-of-life care: results of a multicentre survey

The Lancet: Oncology, Volume 18 – Issue 9: Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care

July 31, 2017

Canadian Medical Association Journal, Volume 189 – Issue 30: Validation of quality indicators for end-of-life communication: results of a multicentre survey

June, 2017 

Journal of Critical Care, Volume 39: Development and initial evaluation of an online decision support tool for families of patients with critical illness: A multicenter pilot study

May 1, 2017

Journal of Pain and Symptom Management, Volume 53 – Issue 5: Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel

April 1, 2017

Journal of Pain and Symptom Management, Volume 53 – Issue 4: Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey

September, 2016

Critical Care Medicine, Volume 44 – Issue 9: Predicting Performance Status 1 Year After Critical Illness in Patients 80 Years or Older: Development of a Multivariable Clinical Prediction Model

August 17, 2016

BMJ Quality & Safety: The prevalence of medical error related to end-of-life communication in Canadian hospitals: results of a multicentre observational study

April, 2015

JAMA Intern Medicine, Volume 175 – Issue 4: Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families: A Multicenter Survey of Clinicians

To live well, age well, and die well, you need to Plan Well