Most patients with serious illness prefer to die at home, yet a majority still die in hospitals.1

Making Choices Michigan (MCM) was formed in 2010 with the vision of creating a community culture where it is acceptable to talk about health care choices, including end of life, and to respect and honor those choices. The mission of MCM is to encourage and facilitate advance health care planning by the people of West Michigan.

Background: A community collaborative Steering Committee was assembled in 2011 to provide stakeholder input for the MCM vision. Members included physicians and administrators from the three main hospitals in Kent County, as well as members from major senior retirement communities, local hospices, attorneys, health plans, geriatric advocacy agencies, state quality improvement agencies, and nursing faculty from a local state university.

With support from the Steering Committee, the MCM Board of Directors contracted with Gundersen Lutheran’s Respecting Choices® program in LaCrosse, Wisconsin. Respecting Choices® has developed an evidence-based, staged approach to advance care planning (ACP). 2

In 2012 MCM launched six Phase I Pilot teams to test the Respecting Choices® infrastructure. The pilot teams included 3 retirement communities, 1 primary care site, 1 cancer and hematology center, and 1 community-based oncology support group. Thirty-five participants were trained as First Steps ACP Facilitators. The six pilot sites developed and implemented the Respecting Choices® “First Steps” program over six months.

Outcomes were measured across all the pilot sites.

  • Completion of advance directives by participants: 158 conversations were facilitated over the 6 pilot groups in 6 months. Of those conversations, 107 (58%) of participants completed the process. Only 2 participants declined any documentation, and 45 (24%) were still in process at the end of the pilot. Twenty-nine participants (16%) were lost to follow-up.
  • Facilitated time spent on ACP process: 65% of the conversations required 30-60 minutes.

Participant satisfaction with the ACP process:

  • Most patients and caregivers were open to the end of life topic, and expressed appreciation for help engaging in open dialogue.
  • Both patients and physicians involved in the pilot felt the open dialogue related to prognosis, treatment plan, and quality of life issues helped them build a mutually acceptable plan of care.

1Dartmouth Atlas of Health Care (2013). End of life care. Dartmouth Institute for Health Policy and Clinical Practice. Retrieved from
2Gundersen Health System (2013). Respecting Choices® advance care planning. Retrieved from