Use of the stages of change transtheoretical model in end-of-life planning conversations

Reports in the end-of-life literature reveal that patients and health care professionals, including social workers, nurses, and physicians, avoid discussions about preparation for such care. End-of-life care discussion barriers include, but are not limited to, professionals feeling unprepared to have the discussions and patients' lack of readiness to discuss planning for this care. Another barrier is the lack of a structured framework to initiate these discussions, especially with clients with advanced illnesses who may not acknowledge that they are at high risk for needing end-of-life care in the future. In a controlled trial of an Advanced Illness Coordinated Care Program, social workers initiated end-of-life planning discussions using the Stages of Change model (SOC). This article describes how the social workers introduced end-of-life planning discussions using the SOC conceptual structure to illustrate the application of a conceptual framework for professionals working with advanced illness populations.