| Patient who is well | Nonurgent |
Have a full, focused ACP conversation during periodic health examinations and when important life events occur (eg, marriage, pregnancy, new job) Emphasize choosing an SDM
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| Patient with chronic disease | Semiurgent |
Have a full ACP conversation during each periodic health examination and when triggered by medical events (eg, new diagnosis, discharge from hospital) If the patient is living with chronic disease, discuss the disease course and potential health outcomes as the disease progresses and at decision points that might arise in the future Revisit at regular intervals as appropriate
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| Patient with acute deterioration in health | Urgent; decision needed now |
Revisit the ACP conversation with the patient or SDM, or initiate the discussion if this has not already been done Discuss code status or goals of care with the patient or SDM at this stage Recommend best treatment based on the patient’s goals, fears, values, and his or her specific illness context Emphasize immediate or anticipated health care decisions
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