1. Planning for end-of-life decisions with your patients
Empower patients to communicate their end-of-life decisions

2. What is an end-of-life letter?
End-of-life letters help to facilitate important conversations about end-of-life care plans between patients, families and caregivers.

3. What does an end-of-life letter cover?
How the patient makes medical decisions
The type of medical care the patient wants and does not want in their final days
How to handle palliative sedation
Any other information the patient wants included

4. Four steps to use end-of-life letters in your practice1
Prepare your practice to use the letter 2
Share the letter with patients and their families 3
Discuss each patient’s completed letter and add it to the chart 8 4
Periodically update the letter as appropriate

5. Empower your patients and your practice
Initiating an end-of-life letter conversation: use this tool to begin the end-of-life letter conversation with your patients
Empower your patients and your practice

6. How is it working at other practices?
Stanford, CA
Steps in Practice Summary - Stanford University Department of Medicine in Stanford, CA
April 2015: Stanford University Department of Medicine developed the letter template to guide patients through the process of making end-of-life decisions
Complement to an advance directive talk about what matters to them on a personal level unrelated to their medical care, describe their preference for how they make medical decisions, etc.
Families and patients appreciate the opportunity to convey their decisions and preferences through the letter
At Stanford, a large multi-disciplinary committee is working to implement the letter in both the inpatient and outpatient settings (it is also EHR-compatible)

7. For additional resources, frequently asked questions and implementation support, visit