More people are doing advance care planning (ACP), creating living wills, and stating their preferences around medical interventions if they get seriously ill.
But how can you best support making these difficult medical decisions as you age?
“Make sure you have good health literacy,” says Dartmouth Health Clinical Investigator and Chief Research Officer Angelo E. Volandes, MD, MPH, who has done a lot of research around medical decision-making.
Good health literacy means being able to get, understand, and discuss relevant health information to make the most informed decisions you can.
“It means having conversations with your medical team and getting other forms of decision-making support that will educate you on how a condition will affect you, what your treatment options are, and how you can be best supported,” says Volandes.
Here are some ways you can increase your health literacy when it comes to decision-making around serious illness.
Understand what ACP means
ACP is an important element of medical decision-making. It is a process of planning for future medical care if you become seriously ill or are incapacitated.
It allows you to explore, discuss, articulate, and document medical preferences that align with your values and goals.
It includes identifying the care you want in different situations and who you want to make your healthcare decisions if you cannot make them yourself.
“Think of it as an ongoing conversation,” explains Volandes.
Ongoing is particularly important because your views, available treatment, and your situation can change over time.
Know you’re not alone
Every day, thousands of older Americans and their families confront difficult decisions about serious illness.
And while there might be no standardized way for doctors and patients to talk about medical decisions, you can assume the medical provider treating you has dealt with similar concerns and questions to yours.
So when you think about ACP, don’t be afraid to ask members of your healthcare team questions and to request resources.
These people can help you compare options and make a recommendation based on your health and priorities. Consider asking:
- What should I expect from my illness over the coming months? What is uncertain?
- What are my options, and what could happen if I wait or choose a different approach?
- What benefits, side effects, and burdens are likely for someone in my situation?
- How could each option affect my time at home, independence, and ability to do what matters to me?
- Given my goals, what do you recommend, and why?
- Who can help with symptoms, emotional concerns, or support for my family? (These recommendations can be provided alongside treatment for the disease).
Don’t hesitate to request that they answer in plain language or ask for an interpreter if needed. A written summary can be helpful, as can bringing someone you trust to the appointment.
Once you have an idea of your plan, try explaining it back to them in your own words and ask whether, based on what you discussed, your summary sounds accurate.
Familiarize yourself with advance care directives before you write yours
An advance care directive, or living will, often comes out of an advance care planning process.
According to the National Institute on Aging (NIA), these are legal documents that provide instructions for medical care and go into effect if you are cognitively or otherwise incapacitated, such as when you are in a coma.
According to November 2025 research from Pew Research Center, more than one in three adults say they have created a living will or advance care directive. That percentage rises to 64% of adults in their seventies and 44% of adults in their sixties.
To create one, you’ll need to have thought about issues like these listed by the NIA, which include items such as whether you want a ‘do not resuscitate (DNR)’ order or life-prolonging interventions. Some people use a lawyer, but one is not required. But before you even begin getting into details like these, the NIA recommends you first:
- Reflect on your values and wishes
- Talk with your doctor
- Choose someone you trust to make medical decisions for you
And even after you have completed your form, the NIA suggests you be willing to revisit the document as your situation changes.
You can get information and an advance care directive from non-profit organizations like CaringInfo or the AARP.
The Vermont Department of Health provides this resource.
The Foundation for Healthy Communities–a nonprofit that works with hospitals, community partners, state departments and insurers–offers this information for New Hampshire residents.
Don’t immediately rush into add-on directives
A newer development that sometimes comes out of ACP is the dementia directive, which maps out the effects of mild, moderate, and severe dementia and asks you to specify which medical interventions you want when.
According to the Dartmouth Dementia Directive, “Standard advance directives may not thoroughly cover the situation of dementia, since the loss of decisional capacity in dementia is gradual, occurring over a long period of time.”
But these directives can be controversial.
Opponents say that a person living with advanced dementia often develops entirely new sensibilities, experiencing happiness or finding comfort in the present moment, even if they previously stated they would prefer death.
Use videos to support the conversation
A video can help you better picture what you will face with a certain condition, including dementia, says Volandes.
Volandes was a coauthor of a study published in 2009 in the British Medical Journal that found that seeing a video of an elderly woman with dementia impacted the care patients chose. Having seen the video, patients chose comfort care over limited care or life-prolonging care at much higher rates than those who had not seen the video.
Then, when participants were contacted six weeks later, only 6% of patients who saw the video had changed their preference for care, compared with 29% of those who did not see the video.
“The results suggest that patients who watched the video had a better understanding of the disease and felt more secure in their decision,” Volandes told Time Magazine after the study was published. “We felt those results were promising, as the goal for end-of-life decisions is to make sure [the patients] are informed.”
Learn how else visual image aid tools might support your decision-making
Since the dementia study, Volandes has continued to do research using videos to help patients better understand unfamiliar treatments and provide additional questions to ask their clinicians.
He has looked at video support tools in ACP in trials like this one for general healthy populations and this one for older patients who initiated ACP in an emergency room.
He has conducted clinical trials around video use in making decisions around specific conditions such as advanced cancer, advanced heart failure, and advanced chronic kidney disease.
When combined with a written, audio or video statement of your personal goals and preferences, he says videos can serve as a balanced decision aid to help you better articulate what you want in treatment and care.
By balanced, he means the aid presents options fairly, without steering you toward a particular treatment.
To explain how balanced decision aid tools with video can work, Volandes points to his VIDEO-KD trial around advanced chronic kidney disease just published in JAMA Internal Medicine.
For the study, he and other researchers studied 453 adults aged 65 and older with advanced kidney disease. The intervention combined a video explaining treatment options with an opportunity to create a written, audio, or video statement of personal goals and preferences for their clinician.
Trained nurses and social workers delivered the intervention and then sent the patient’s statement to the treating clinician.
Within 12 months, ACP was documented for more than half (56.6%) of the intervention group, compared with less than half (40.0%) receiving usual care.
“The video helps patients understand medicine, and the declaration helps medicine understand the patient,” Volandes said when the results were announced.
These balanced decision aids, Volandes explains, can come in the form of videos, booklets, or online tools. He encourages patients to ask their care team for balanced decision aids to help them understand their options. Whether a particular tool is available will depend on the practice and the decision. You can also look through the Ottawa Hospital Research Institute’s decision aid directory, he says.
What’s next
Volandes believes there is a lot of potential for visual aid tools to help patients make better decisions about how to treat and cope with many serious illnesses.
Volandes is currently one of the chief investigators of a $44 million study known as Advancing Ethical Goals in Society (AEGIS) trial that is NIA-backed. The trial, he says, will test whether decision-aid tools can help patients and families better understand their options, explore ways for patients to communicate what matters most to them, and help identify how to better navigate an increasingly complex healthcare system to get care that honors patients’ wishes.
Results of the study are expected over the following five years.
In the meantime, videos that might help with a range of conditions are available online with these organizations:
- PREPARE for Your Care: A free, step-by-step interactive video program featuring physician explanations, visual examples, and tools to help patients navigate medical decision-making and build actionable summary plans.
- MyDirectives: A free digital platform that includes digital and visual/audio options for healthcare proxies and clinicians.
