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Helping You Help Our Patients

We encourage our valued providers and healthcare partners to take advantage of these resources to help you guide and support advance care planning discussions with your teams and patients.
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Please Note

The external websites linked to from this webpage contain the information and viewpoints approved by those organizations. While we do believe these websites contain valuable resources that may be useful to you, these links do not represent an official endorsement of any other organizations' materials by Inova Health System.

Ascertaining and understanding a patient’s wishes is an important component of high-quality care. Clinicians should always ensure patients receive care that aligns with their values and goals. With the new reality of the COVID-19 pandemic, the importance of providing goal-concordant care has become heightened. Now more than ever, it is crucial for people to have these important personal conversations with their healthcare providers and families and to make decisions prior to the possible development of serious acute illness.

As medical providers, the types of conversation you may have with your patient about health care goals and wishes will vary based on your patients’ current condition and location of care. 

The palliative care and geriatric teams, along with medicine leadership at Inova have compiled this list of resources to help you guide your patients in expressing their healthcare wishes, verbally and in writing.

Primary or Specialty Care Clinic - Advance Care Planning

Community and Post-Acute Partners (e.g., Assisted Living Facility, Home Health, Hospice, Skilled-Nursing Facility) – Advance Care Planning

What is advance care planning (ACP)?

Advance care planning (ACP) is the process of planning for future medical care, particularly in the event the patient is unable to make the patient’s own decisions. ACP should be a routine part of standard medical care. ACP may include advance directive documents such as a living will, a healthcare power of attorney or a healthcare proxy.

Why is ACP important?

ACP allows you to state your choices for healthcare or to name someone to make those choices for you in the event you become unable to make decisions about your healthcare yourself. Putting your wishes in writing ahead of time will reduce any confusion that your loved ones or healthcare team may face regarding your healthcare wishes.

What documents are part of ACP?

ACP includes several documents:

  • An advance directive and living will – a written document stating a patient’s wishes about healthcare decisions in the event the patient becomes unable to make healthcare decisions in the future
  • A durable do not resuscitate (DDNR), physician’s orders of scope of treatment (POST) or equivalent form – a signed medical order for specific healthcare to be provided to, or withheld from, a patient in the event of a medical emergency, such as cardiac arrest
  • A guardianship or custody document – a court document granting decision-making authority to a guardian or custodian for a patient deemed legally incompetent
  • A power of attorney – a legal document granting decision-making authority over medical or financial affairs (or both) for a patient in the event of future incapacity

Learn More About Advance Care Planning Document Types

Who can have ACP conversations?

An ACP conversation can be started by any member of your care team or support network (e.g., family members, neighbors, friends). Several disciplines can bill for these conversations.

How do I access my patients' ACP documents on file at Inova?

EpicCare Link is a free, enhanced read-only application offering community providers secure, remote access to view their patients' Inova medical records. Learn more

How do I share my patients' documents with Inova?

It is important for Inova to have a copy of your patients’ most recent ACP documents as soon as they are available. Fax them to us at 571-472-6505.

What training and educational resources are available?

Additional Educational Resources:

COVID-19 Resources

Topics include Advance Care Planning During a Crisis for Nursing Homes, CALMER Goals of Care Discussion Guide, Symptom Management in the Nursing Home During COVID-19, and links to the End-of-Life Nursing Education Consortium (ELNEC).

Hospital Resources – Goals of Care