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Easier, More Meaningful Advance Healthcare Directive

"What makes my life worth living?"

A new Cedars-Sinai Advance Healthcare Directive was designed to spark this type of soul-searching.

"We want this directive to make people think about what's important to them, what quality of life they would be willing to accept and what they most value," said Bradley Rosen, MD, vice president of Physician Alignment and Care Transitions and co-leader of the Quality Council's Advance Directive Redesign Working Group. "These aren't yes-or-no questions. You have to dig deeper."

An Advance Healthcare Directive is a legal document that can be referred to in the event you are unable or don't want to participate in medical decisionmaking. In the directive, you can name someone who can make medical decisions on your behalf. You also can state any goals, values and preferences concerning your healthcare.

The Advance Directive Redesign Working Group—a multidisciplinary team with members from Chaplaincy, Communications, Healthcare Ethics, Nursing, Performance Improvement, Pharmacy Services, Primary Care, Risk Management and Supportive Care Medicine—was charged with improving the directive that's been used at Cedars-Sinai for the past several years. Patient and clinician feedback indicated the document should be shorter and less confusing. The working group also felt the directive should allow patients an opportunity to provide more meaningful information about themselves.

"We wanted a document that would enable us to really know who you are as a person and what matters to you," said Stuart Finder, PhD, director of the Center for Healthcare Ethics and member of the Advance Directive Redesign Working Group.

Achieving that goal proved challenging.

"The process was intense," said Rosen. "Over the course of a year, we went through at least 30 drafts, engaged in multiple brainstorming sessions, elicited feedback from 12 specialty areas and several hospital committees, and made substantive changes every step of the way." 

That intense process culminated in a newly printed Advance Care Planning packet that's available at nursing stations throughout the medical center, at outpatient clinics, and on both the Cedars-Sinai intranet and the Cedars-Sinai website.

The packet comes in a folder containing the Advance Healthcare Directive and a step-by-step guide that walks users through the entire directive. There are optional sections on topics such as organ donation and funeral arrangements. Worksheets also are included so users can indicate what quality of life they're willing to accept.

"I really like what we created. It provides so much more useful information to help us better know who we're taking care of, and to ensure the care we provide is fitting for them as a person," said Finder.

Rosen agrees. "The new packet is nicely organized and much easier to navigate. The contents represent a significant step forward to educate people about the purpose of an Advance Healthcare Directive and to elicit more meaningful, actionable information," said Rosen.

The folder also includes a flyer for Cedars-Sinai's free Advance Care Planning classes, offered twice a month to the public, Cedars-Sinai employees, patients and families. The classes are taught by licensed clinical social workers who explain the purpose of an Advance Healthcare Directive, orient people to the new packet and offer attendees assistance in completing their own directives.

The days and times of the class are:

  • The fourth Tuesday of each month, from 10 a.m.-noon at 8501 Wilshire Blvd., Suite 340.
  • The fourth Tuesday of each month, from 6:30-8:30 p.m. in the Advanced Health Sciences Pavilion, PEC Room 4.

To sign up for the class, call 800-700-6424.

Jaime Goldberg, LCSW, a clinical social worker with Supportive Care Medicine, teaches the Tuesday evening class and was an active member of the redesign team.

"I always emphasize that, as the name suggests, an Advance Healthcare Directive should be completed before any illness or injury occurs," said Goldberg. "Don't wait until you're older or sick. You can complete an Advance Healthcare Directive when you turn 18."

Goldberg noted that creating the new packet was painstaking, but well worth the effort.

"The new directive is much more user-friendly and it really humanizes the person," said Goldberg. "They're sharing what they truly value in life and that informs how we provide care."

To further roll out the new packet, training sessions will be held for select areas, and overview presentations will be given across the medical center.

To request a training session, contact

Advanced Healthcare Directive (PDF)  

Step-by-Step Guide (PDF)