The John A. Hartford Foundation is pleased to collaborate with the California Health Care Foundation and Cambia Health Foundation in conducting a national survey and series of focus groups on improving Advance Care Planning, as well as exploring the barriers that can make these important conversations more challenging. 

On this page you will find:

Information on the “Conversation Starters” focus groups with clinicians as well as consumers, released December 1, 2016. 

Information on the “Conversation Stopper” physician survey, released April 2016.


"Conversation Starters” Focus Groups with Clinicians and Consumers

Discussions about end-of-life and serious illness care, which are now reimbursable through Medicare, make it more likely that patients will receive the kind of care they want, yet these critical conversations often fall short, start too late, or don’t happen at all. New focus group research provides insights into practical ways to improve advance care planning (ACP).

The John A. Hartford Foundation, the California Health Care Foundation (CHCF), and Cambia Health Foundation commissioned “Conversation Starters”: six focus groups about advance care planning made up of clinicians (general practitioners, internists, oncologists, cardiologists, pulmonologists, nurse practitioners, and physician assistants). A seventh focus group, composed of 31 racially and culturally diverse adults age 40+ who have an advance care plan, was conducted online. The focus groups were conducted by PerryUndem Research/Communications.

For more information on the focus groups, please explore the following materials: 


Media Coverage

Chicago Tribune: Doctors slow to have end-of-life conversations

MedPage Today: End-of-Life Talks: Vital But Not Happening


“Conversation Stopper” Physician Survey

In April 2016, The John A. Hartford Foundation, California Health Care Foundation and Cambia Health Foundation released findings from a national poll exploring the views of primary care and specialist physicians about end-of-life and advance care planning conversations with patients.

In Conversation Stopper: What’s Preventing Physicians from Talking with Patients about End-of-Life and Advance Care Planning? virtually all physicians surveyed agree that talking with patients about end-of-life and advance care planning is important, and they overwhelmingly support a new Medicare benefit that reimburses them for having those discussions. The survey also identified barriers that keep physicians from engaging in these sensitive conversations, with nearly half (46 percent) reporting that they frequently or sometimes feel unsure of what to say, and less than one-third (29 percent) reporting having had any formal training specifically on talking with patients and their families about end-of-life care.

For more information on the survey, please explore the following materials: 


Media Coverage

Associated Press: Elderly book end-of-life talks once labeled 'death panels'

Boston Globe: Most doctors ill-equipped to give end-of-life care, survey finds

Forbes: Doctors Have Barriers To End-Of-Life Discussions Despite Medicare Coverage

Marketwatch (Dow Jones): You need to talk to your doctor about how you want to die

Also appeared on

Reuters: COLUMN-U.S. Medicare end-of-life counseling off to slow start

The Atlantic: Discussing Death Over Dinner

Also appeared in Retirement Revised.

Kaiser Health News/California HealthlineMost Doctors Unsure How To Discuss End-of-Life Care, Survey Says

This story has also been reprinted widely in the following publications:

Next Avenue: Dinner Parties Encourage Talk About Death

Also appeared on

The Washington Post Writers Group syndicated writer Esther Cepeda

Des Moines Register: When Doctors Talk About Dying

MedPage Today: Docs Still Flinching on Advanced Care Planning

Medscape: End-of-Life Conversation Stoppers Revealed in New Survey

Long-Term Living Magazine: Having 'the talk' about death


McKnight's Senior Living: Survey reveals barriers to end-of-life, advance care planning discussions

New America Media: Study: With New Medicare Benefit, Doctors Look Beyond 'Death Panels'

The Hill: Poll: Doctors find barriers to end-of-life talks

Becker's Hospital Review: 24% of physicians say their EHRs can't accommodate end-of-life planning

Fierce Practice Management: Lack of Physician Training Still Hampers End-of-Life Conversations

Tech Times: Doctors Find It Difficult To Advise Patients About End-Of-Life Care Physicians Face Barriers to Have End-of-Life Conversations with Medicare Patients

Las Vegas Review Journal: Time to Discuss End-of-Life Decisions is Now, National Healthcare Decisions Day End-Of-Life, Palliative-Care Discussions Are Hard, Even For Doctors

The News Recorder: Doctors Says Talking With Patients About End-Of-Life Care Difficult But Very Important

Hospice and Palliative Medicine SmartBrief 

Assisted Living Federation of America / Argentum: Doctors Find Themselves Stumped When Discussing End-of-Life Planning

Pulse Headlines: Is the U.S. healthcare system ready to talk about end-of-life wishes?

ThinkProgress: What Doctors Should Be Asking Their Patients About How They Want To Die

Today’s Hospitalist newsletter: Weekly News Briefs for Hospitalists

DecisionHealth Part B News (subscription): Survey: M.D.s find lack of time, patient-family conflict obstacles to ACP

Ventura County Star: Push for living wills places focus on end-of-life desires

Mirror Daily: End-of-Life Talks are Hard for Doctors

News Everyday: Doctors Find Discussing End of Life Care Difficult to Patient, Study Finds

Visiting Nurse Association of America: Health Care Collaboration Releases Poll Findings on End-of-Life and Advanced Care Conversations

The Pew Charitable Trust: Poll: Doctors Want to Discuss End-of-Life Issues, but Barriers Remain

Health Payer Intelligence: End-of-Life Counseling Sessions Stall despite Medicare Payment

Health Leaders Media: Despite New Funding, Few Docs Discuss Advanced Care Planning

Background on the Poll

This survey of 736 physicians in 50 states who see patients 65 and older was conducted by PerryUndem Research/Communications and has a sampling margin of error of +/- 3.6 percentage points. It was released April 14, 2016.

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