First Steps® (FS) is appropriate for any healthy adult over the age of 18 or who may have a chronic illness but has never prepared an advance care plan. The goals of this stage are to motivate patients to plan, assist in selecting a qualified healthcare agent/decision maker, provide instructions for goals of care in the event of a permanent and severe neurologic injury, and complete a basic document.
Next Steps (NS) is offered to patients when chronic illness becomes more advanced—when clinical triggers arise, such as complications, frequent hospitalizations/clinical encounters, or a decline in function. For a patient with heart failure, it may be a heart attack, pulmonary complications, or increased symptoms during daily living activities.
Advanced Steps (AS) is initiated as a component of quality end-of-life care for frail elders and those whose death in the next 12 months would not be unexpected. The AS planning conversation is focused on goals of care to make timely, proactive, and specific end-of-life decisions. Ideally, these decisions are converted into medical orders that can be followed throughout the continuum of care. The Physician Orders for Life-Sustaining Treatment (POLST) program is the nationally recognized model for this stage of planning.
