The VA Life-Sustaining Treatment Decisions Initiative - National Center for Ethics in Health Care
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National Center for Ethics in Health Care


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The VA Life-Sustaining Treatment Decisions Initiative

The Life-Sustaining Treatment Decisions Initiative (LSTDI) is a national VHA quality improvement project led by the National Center for Ethics in Health Care (NCEHC). The aim of the initiative is to promote personalized, proactive, patient-driven care for Veterans with serious illness by eliciting, documenting, and honoring their values, goals, and preferences.

The initiative involves a new national policy to standardize practices related to discussing and documenting goals of care and life-sustaining treatment decisions, and the tools, resources, education, and monitoring to support clinicians and facilities in making practice changes.

Links and Files

Goals of Care Conversations
Resources for Veterans, Families, and Health Care Surrogates

GoCC Sticker

If you have a serious illness, talk with your VA doctor about what matters to you. Set up a time to have a goals of care conversation with your doctor or others on your VA health care team about your medical condition, what matters to you in your life, and how your health care might help you achieve your goals.

The Setting Health Care Goals handout for patients, families, and health care surrogates explains the nature and purpose of goals of care conversations, helping prepare them for a discussion about the patient’s goals and life-sustaining treatment decisions. YouTube and podcast versions are also available.

Dialed In Podcast Series

Setting Health Care Goals When You Have A Serious Illness (5:56)

Would CPR Be Right for Me? (4:51)

Mechanical Ventilation — An Option for Breathing Problems (6:05)

Choosing A Health Care Agent (5:36)

Other Resources for Veterans including resources to advance care planning and planning for future health care for all Veterans, including Veterans who do not have a serious illness. 

National Policy

VHA Handbook 1004.03, Life-Sustaining Treatment Decisions: Eliciting, Documenting, and Honoring Patients’ Values, Goals, and Preferences 

Frequently Asked Questions


LSTDI Overview and
VA Implementation

LSTDI Overview Video

LSTDI Overview PowerPoint

LST and Advance Directives Podcast

Step-by-step Implementation Guide (used in VA to successfully implement LSTDI)

Video: Conducting a Goals of Care Conversation with a Patient


Goals of Care Conversations
Skills Training

Skills Training Materials for VHA Staff

Skills Training Materials for Non-VA Healthcare Professionals