"Conversation Ready": A Framework for Improving End-of-Life Care (Second Edition)

"Conversation Ready": A Framework for Improving End-of-Life CareThis white paper presents IHI’s "Conversation Ready" approach to help health care organizations and clinicians provide respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.

The framework is relevant whether you are a leader in a large hospital, a social worker in the community, a doctor in a clinic, or a palliative care nurse in a skilled nursing facility.


The second edition is an update of the original 2015 white paper, based on additional learning from several years of work with dozens of diverse health care organizations and hundreds of health care professionals.

The white paper:

  • Defines five interconnected Conversation Ready principles;
  • Calls out the consequences of inadequate advance care planning and disrespectful care as forms of preventable harm;
  • Guides readers through an in-depth examination of the concepts that underlie the Conversation Ready work and the factors that contribute to unreliable advance care planning;
  • Encourages taking a systems perspective to build more reliable processes for advance care planning and providing respectful care at the end of life; and
  • Provides recommendations about where and how to begin, including examples of changes other organizations have tried and suggested measures. ​

How to Cite This Paper: Sokol-Hessner L, Zambeaux A, Little K, Macy L, Lally K, McCutcheon Adams K. “Conversation Ready”: A Framework for Improving End-of-Life Care (Second Edition). IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2019. (Available at ihi.org)

Related Information:

How to Talk to Your Patients about End-of-Life Care: A Conversation Ready Toolkit for Clinicians

This toolkit describes key considerations and provides example "conversation starters" to help guide clinicians in engaging patients and families in end-of-life care conversations over time.
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