advance care planning, end-of-life care, population segmentation, precision health, theoretical framework



  1. Sullivan, Suzanne S. PhD, MBA, RN, CHPN


Advance care plans (ACP) align care with individual values and goals for the end of life, yet their rates are low. Communication barriers are a primary reason for these low rates. Precision health approaches that target individuals based on personal needs, behaviors, or choices may improve communication and positively influence rates of advance care plans. A framework to guide these efforts is needed. The purpose of this study is to develop a framework that guides clinicians in identifying individuals who will benefit from targeted advance care planning conversations. Walker and Avant's theory derivation strategy integrates concepts of social marketing theory, population segmentation, the marketing mix, and the transtheoretical model of behavior change into a novel framework. The Aligning Individuals with Meaningful End-of-Life Discussions to Promote ACP (TakingAIM) model promotes population segmentation by integrating social marketing theory and the marketing mix into conceptual definitions within the context of ACP: plan (product), perception (price), preference (promotion), and pathway (place). The transtheoretical model of behavior change further guides ACP conversations at the individual level. Identifying at-risk groups and targeting their specific needs may improve the rates of advance care plans. This framework is appropriate for use in any clinical setting and is ready for empirical testing.