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How is 6-Steps different than other living will protocols?

There are many advance-care-planning protocols available on-line and in print, distributed to the general public or patients affiliated with healthcare facilities. Using the International Patient Decision Aid Standards (See Elwyn et.  al.), many of the existing instruments satisfy some but not all recommended criteria. Although it is not perfect and will undergo continuous revision in response to user and professional feedback, 6-Steps provides all three of the elements required for an effective living will and offers a faclitative guide to their completion. As summarized in the Table below, it has also been designed to  correct most of the flaws that commonly weaken other approaches.  

Other protocols

Many charge for all or part of the materials required by their programs.

Suggest conversations with loved ones and doctors but do not produce written records, subjecting the decisions to all the potential errors of human memory.

Many advance directives are incomplete or too vague.

Almost all use a limited range of end of life treatments that may not apply to patients' actual conditions and patients are asked to choose treatments for illnesses they can't imagine having.  


6-Steps offered as a public service that provides materials and guidance without charge.

Surrogates often do not know that they have been chosen, and when they do know, they cannot clearly state the wishes of the person they represent.

Most are treated as one-time events when in fact they should be part of an evolving process.

6-Steps encourges frequent conversations, with updated written documents so the choices will be accurately recalled.  

6-Steps includes all of the information needed for end-of-life care planning with a level of specificity that clarifies the desired actions.

6-Steps uses a personal statement of patients’ values and wishes to fill in the blanks that are inevitable in advance directives, including principles to guide treatment of unanticipated illnesses.

6-Steps is created through discussion with surrogates who therefore know and can accurately represent the person’s wishes.

6-Steps advises users to have on-going discussion with family members, surrogate, and providers about their end-of-life values, goals, and Living Will, revising when needed.

6-Steps prompts repeated discussions with providers that allow them to get to know their patients as people who have unique end-of-life care wishes.

Most are often unknown to providers who were either not involved in their creation or forgot that they were created.

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