GOCCNJ Your CarePlanYour CarePlan™ is a web-based program that makes it easy for healthcare providers (HCPs) to complete POLST (Practitioner Orders for Life Sustaining Treatment) forms, helps reduce hospital readmissions and enables you to deliver care that is better aligned with your patient’s wishes.

What is Your CarePlan?

Your CarePlan is a video-guided program that helps healthcare providers (HCPs) complete POLST forms with eligible patients in long-term care facilities, hospitals, and community practices. Guided scripts, gentle prompts and short, straight-forward informational videos simplify the conversation about goals of care and choices for treatment and facilitate POLST documentation. As each section is completed, the answers automatically populate a POLST form which can then be printed for the patient and authorized HCP to sign.

Photo of physician talking with senior patient
“Your CarePlan made the POLST conversation feel natural and comfortable for our staff and patients.”
—Joanita M., LCSW, Long-Term Care

How Does it Help?

Using Your CarePlan to complete a POLST form:

  • Makes it easy to have these often uncomfortable conversations
  • Improves patient health literacy
  • Ensures informed consent
  • Reduces unnecessary hospital readmissions
  • Increases referrals and earlier access to palliative and hospice care
  • Reduces the burdens of serious illness on patients and caregivers
  • Helps HCPs deliver care aligned to a patient’s values and goals

Valuable Resources for Providers and Patients

Your CarePlan includes:

  • Four training modules covering topics such as identifying appropriate patients, best practices for conducting care plan meetings, documentation and billing.
  • Regular support calls to coach staff and help with implementation.
  • A training manual.
  • A series of videos that help the patient/medical decision-maker prepare for the care planning discussion.
“We found the quality of our conversations with patients improved after we started using Your CarePlan. And, we’ve completed so many more POLSTS!”
—Laurie P., LCSW, Community-Based Practice

Your CarePlan in Clinical Practice Real world evidence (RWE) obtained from 326 provider and patient POLST conversations using Your CarePlan resulted in:


36% of patients electing DO NOT HOSPITALIZE (DNH)1

  • 36% 36%

98% of patients electing DO NOT RESUSCITATE (DNR)1 DO NOT INTUBATE (DNI)1

  • 98% 98%

A recent study2 found that when HCPs used Your CarePlan, they achieved high rates of:


  • 99% 99%
  • 48% 48%

* p<0.001


Patients Electing Limited or Symptom Treatment

  • 96% 96%
  • 80% 80%

* p<0.001


Patients Electing No Artificial Nutrition

  • 77% 77%
  • 54% 54%

* p<0.0001

Patients Using Your CarePlan (n=112)

Control Group (n=214)

1. Data on File. GOCCNJ; RWE Sept. 17, 2018 – March 11, 2020.

2. Data on File. GOCCNJ; Pilot Study, Jan. 2017 – Dec. 2017.

To learn more about Your CarePlan and how it can reduces hospital readmissions and enhances the delivery of high-quality, goal concordant care in your facility or private practice, please contact us.