ACP as a Public Health Issue
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Health behavior is influenced by many factors at various levels of society. The individual, interpersonal, institutional, community, and policy levels are impacted by economic, political, and social factors. Institute of Medicine (IOM) has identified ACP as a public health issue that could be addressed by the community as one part of the health care system. ACP research experts defined ACP as a progression of behaviors including conversations between individuals, surrogates, and medical practitioners as well as completion of an advance directive. ACP behaviors have been referred to as health behaviors by some researchers, while others have recommended addressing ACP as a health promotion activity to improve participation rates and normalize such conversations. ACP behaviors include articulating personal values, selecting a surrogate, discussing surrogate leeway in decision making, and informing others of the decisions in addition to completing ACP documents. In addition, the IOM endorsed ACP as a continuous lifelong behavior that should begin early with everyone including children who have the capacity to participate in making health care decisions.