End-of-Life Care Plan Template with Examples

End-of-Life Care Plan Template

This End-of-Life Care Plan (EOCPL) Template is created to help palliative care practitioners efficiently assess the needs of patients approaching the last stages of life. It documents their medical plans, understands their treatment preferences, and structures advance care planning. Using this template from Heidi, clinicians can easily:

• Record essential patient information, including relevant history and current diagnoses.
• Capture details from patients’ advance directives to legal and ethical considerations.
• Plan next steps and send follow-up documents to family, carer, or broader care teams.

View Template

What is an End-of-Life Care Plan?

An end-of-life care plan (EOLCP), also often referred to as advance care plan, is a structured document that honors a patient’s medical wishes, preferences, and goals as they approach the end-of-life.

End of life care planning does not only involve medical or psychosocial support, but it should also provide spiritual and emotional care. Since end-of-life care plans involve different carers, legal considerations such as a living will should also be discussed.

In this article, we will break down the key elements of an end-of-life care plan template and provide a ready-to-use, AI-enabled example to allocate more time to more important aspects of care.

Why are End-of-Life Care Plan Templates Essential?

Using a structured template provides clinicians with a way to enable open communication between the individual, the family, and the healthcare team. In turn, this gives peace of mind to family members or carers as it offloads the emotional burden during a difficult situation.

This claim is backed by a study from the Journal of Palliative Care, where it was found that the timely implementation of an EOLCP template enabled the delivery of better end-of-life care. This reiterates that the use of an EOLCP template is essential for carrying out structured and dignified care for patients. 

A comprehensive end-of-life care plan template outlines each key aspect of care that an individual needs when facing end-of-life. It is primarily designed to acknowledge the preferences of the patient so they feel respected and cared for. These aspects are outlined below.  

Key Elements of an Advance Care Plan Template

Care plans look different for each individual, so it is naturally important for an advance care plan template to include vital information. It also helps healthcare professionals reduce time and effort in filling out a template. Below, we will talk about the key elements of an advance care planning template.

Patient Information and Current Clinical Status

The template generally includes key personal information, current diagnoses, and relevant medical history.

Clinical Preferences and Carer Involvement

To make the goals of care more specialized, the template entails the treatment and intervention preferences of the individual. If explicitly mentioned, a template can also list the preferred place of care and death, which can be any facility requested by the patient.

Questions as to who is involved in the decision-making for the patient should also prove useful and vital. A good template documents discussions with family members and carers. A great template adds a way to streamline communication arrangements and referrals to hospice care.

Plans for Symptom Management

This section highlights the current pain and symptoms experienced by the individual and the impending plans laid out to manage them.

Psychosocial and Spiritual Support

For a more holistic approach, the template usually integrates the spiritual dimension of an individual’s preferences. Should there be other cultural, psychosocial, and emotional concerns, the template identifies and describes those deliberations.

Legal and Ethical Considerations

Medicolegal factors should be considered for every care plan as well. For patients who are able to comprehend and communicate effectively, informed consent should be given prior to medical procedures. In the same vein, every patient has self-autonomy. They are right in making decisions such as refusing to undergo medication or treatments. Such details should be captured in the advance care plan template.

The required depth and scope of documenting end-of-life plans is a current challenge clinicians face. Before Heidi, clinicians at Compass House Medical Centre dealt with administrative challenges as the practice grew. This significantly increased the pressure and the stress of the endless need to document comprehensive notes. 

"With the workload pressure, I often had no brain capacity in that space during clinic, so I had to leave the documentation to the end of the day, but by then, I was exhausted," says Ian Parsonage, incumbent Nurse Partner and Lead Advanced Care Practitioner at Compass. Thankfully, with Heidi, clinicians are now able to engage in additional projects and practice improvements.

How to Create an End-of-Life Care Plan Efficiently

A holistic approach for patient-centered care allows for an efficient, thorough, and thoughtful plan for the patient’s wishes. In this section, let’s take a look at how you can create your comprehensive care plan:

Prepare existing records

Prior to a consultation, prepare patient records, tests, treatments, or other documents that contextualize a patient’s medical history. With an AI-enabled tool like Heidi, you can use the context feature which allows you to input spoken or encoded patient information. For future sessions, this also allows you to access additional patient background, present a problem, or any specific points that you want in your final output.

Conduct an end-of-life assessment

Now that we have discussed the key elements of an advance care plan, it’s time to conduct an assessment covering the details mentioned. Instead of downloading a worksheet, Heidi generates the ready-to-use end-of-life assessment template which you can further personalize.

Communicate with family

When a session ends, family members or primary caregivers are legally allowed to be informed about the medical and legal decisions made by the patient. After using Heidi’s note template, you can easily generate the following document that relies on your session notes. This means that Heidi will create two outputs for you, and for this example, you can generate a document like a letter of intent or a letter of competency. 

Inform hospital staff

To provide optimal patient care, the rest of the healthcare team members involved must be informed of a patient’s status after an end-of-life assessment. To make sure you don’t miss out on administrative tasks post-consult, Heidi helps you identify action items from your notes and lists them in the same session. As this happens automatically, you may also add tasks manually, edit details, delete, or mark as done.

End-of-Life Care Plan Template Example

End-of-life documentation can be emotionally taxing as it requires rigorous and careful assessments. Since patients in this stage require the utmost human attention, manually filling out notes may lead to missed information, compromising the overall quality of end-of-life care. Thankfully, AI-powered end-of-life care plan templates are now available to ensure that documentation is accurate and efficient.

Make end-of-life care planning easier with Heidi

At Heidi Health, we offer a free, easy-to-use end-of-life care plan template designed to make your documentation faster and more personalized, and more accurate. With your patient’s permission, simply hit record and let Heidi work as you go. On top of that, you will save more time for more important things because Heidi helps you:

• Transcribe: Open Heidi on your PC or mobile device and press Start transcribing so Heidi will capture your conversation with the patient in the background. For information that you don’t want to verbalize, you can type it under the context notes to be considered later.
• Customize: After the session, select your preferred end-of-life care plan template and watch as Heidi perfectly captures the details of your conversation and context notes in the appropriate fields and format.
• Transform: Once it generates your completed end-of-life care plan template, you can ask Heidi to give additional documentation, including ACP documentation as needed.

Heidi supports over 1.5 million patient consults every week, complying with global standards and regional regulations, ensuring data localization for customers in Australia, Canada, the United States, the United Kingdom, and beyond. Read more about our patient safety and data security compliance.

Try for free

Free End-of-Life Care Plan Templates

End-of-Life Assessment Template

This template aids palliative and hospice care professionals in documenting critical information on a patient’s current health status and goals of care. It helps ensure a holistic approach to end-of-life planning.

View Template

Advance Care Planning Documentation Template

This template is a tool designed for hospice and palliative care clinicians to document details of patients’ future-oriented medical decisions. It facilitates discussions around a patient’s wish according to their personal values and treatment goals. 

View Template

Frequently Asked Questions about End-of-Life Care Plan Templates

What is an advance care plan?

An advance care plan is a structured document that is completed by addressing an individual’s medical goals and future preferences when facing end-of-life. Precisely, an advanced directive is a medical record submitted by the individual and is shared to loved ones and the wider medical team. Both documents change over the course of one’s life. These are part of what is called advance care planning (ACP), a process that commonly starts in early adulthood.

What is the difference between end-of-life care and palliative care?

Palliative care supports anyone with a serious illness at any stage. It focuses on relieving symptoms, pain, and stress. On the other hand, end-of-life care is a type of palliative care specifically for people expected to live six months or less. It focuses entirely on comfort when curative treatments are no longer pursued. In short, all end-of-life care is palliative, but not all palliative care is end-of-life care.

What are the 4 goals for end-of-life care?

At the end-of-life, care teams focus on four main goals to support both patients and their families. These goals help ensure comfort, dignity, and peace during a challenging time:

• Physical comfort: Managing pain and other symptoms to keep the patient as comfortable as possible.
• Emotional and mental support: Addressing feelings like anxiety, fear, or sadness for both the patient and their loved ones.
• Spiritual care: Supporting any spiritual or religious needs, helping patients find peace or meaning.
• Practical assistance: Helping with daily tasks and providing respite for caregivers so families can focus on quality time together

What are the three strategies used in end-of-life care plans?

The three strategies that compose end-of-life care plans are: proactive patient identification, needs assessment, and continued support and care coordination. Through these interconnected strategies, end-of-life care teams work together to create a comprehensive care plan in honor of the patient’s wishes at the end of life.