On April 16 the United States observes National Health Care Decisions Day to foster awareness that patients and families have the right to discuss and document their wishes for the care they will receive at the end of life.

True to form, hospices are at the forefront, encouraging patients, families and their clinicians to choose hope over fear — to come together for the most important conversation that no one wants to have.

Advance care planning has gained visibility during the past several years. The trend accelerated in 2016 when the U.S. Centers for Medicare & Medicaid Services (CMS) began reimbursing health care providers for end-of-life consultations.

In the intervening years, a growing body of research has reinforced the assertion that these discussions can increase the likelihood that the goals and wishes of a dying patient will be honored.

Proponents of advance care planning now have an arsenal of data to counter the injurious silence that prevents so many from meeting their final days on their own terms. Goal-concordant care is achievable. Fewer patients will endure futile treatments that they don’t want, and fewer will die in a place they don’t want to be.

So what else remains to be said about advance care planning?

Perhaps this: A beautiful idea can falter with poor execution.

Too often, the end-of-life conversation becomes another nexus point at which patients fall through the cracks of our fragmented health care system. Like hospice, patients are given the option too late, or — as with palliative care — an incomplete delivery system never gives them the option at all.

The reasons for this are sometimes complex, “big-picture” problems, such as the persistent racial and socioeconomic disparities that exist in health care.

Others causes are simple: No one wanted to bring it up, or they didn’t know how.

Most patients expect their health care providers to initiate these discussions at the appropriate time, but 71% say that their physicians have never broached the subject, according to a recent poll by VITAS Healthcare, the hospice subsidiary of Chemed Corp. (NYSE: CHEM). Close to 55% said that no one mentioned it to them at all.

This doesn’t mean that we should all point fingers at clinicians. With sincere devotion and unwavering commitment they continue to fight the good fight for their patients. True to their training, they serve the sick and the dying in all the ways that their teachers, mentors and clinical practice guidelines told them they should.

Unfortunately, that training rarely includes the intricacies of end-of-life discussions, or hospice or palliative care for that matter.

The American Geriatrics Society in 2018 reported that 99% of physicians said they believe that these conversations are important, but only 29% indicated that they had received formal training on how to conduct them.

Moreover, a lack of system-wide coordination frequently means that the right hand doesn’t know what the left hand is doing.

A family may have signed all the right forms without anyone telling them what to do next. They may not understand that the burden of keeping disparate care teams informed will likely fall on them. Otherwise, the next doctor on the assembly line may have no idea those documents exist.

A 2017 study found that only 14% of seriously ill patients had an advance care plan that was accessible through their electronic health records,

Those numbers are a few years old and may have improved, but research published just last month indicates that fragmentation and variation in advance care planning processes continue to undermine the effectiveness of those services.

In this design, the system works if patients and families become the connective tissues that bind its muscles together.

These challenges are real, but they are not the whole story.

Advocates from across the health care continuum are working tirelessly to educate the public and their colleagues about the nature of advance care planning, the potential benefits, how to have the discussions and when to revisit them.

Organizations devoted to improving end-of-life and serious illness care are engaging with providers and policymakers to help them better understand advance care planning and secure the resources needed to make it work.

The National Hospice and Palliative Care Organization, the National Association for Home Care & Hospice, and the Center to Advance Palliative Care are just a few of the names.

Private companies and startups have emerged with tech-enabled platforms designed to make the process easier and more accessible to families. Vynca, ACP Decisions, Koda Health, Iris Healthcare, AdVault, Care Directives, Vital Decisions are just a handful of innovators forming the chassis of a new industry around advance care planning.

Some of these firms have brought in tens of millions in investor dollars, signaling a realization that a huge market exists for these services, and for the time being demand exceeds supply.

A range of organizations — including some of these advance care plan companies, EHR providers, health care agencies and government stakeholders — are working to better integrate the necessary documents into patient health records and make them interoperable.

Though no solution has been sufficiently scaled to date that fully addresses the documentation problem, the health care community is making progress, including those in the vendor space.

Beyond this work, the COVID-19 pandemic has led families to consider their end-of-life wishes in greater numbers, and early evidence suggests that underserved populations are making the largest gains.

For hospice providers, the commitment to honor patients’ choices at the end-of-life speaks to the core of who they are. So where do they fit? Putting aside the macro-level barriers, what can the individual organization do to help move the needle?

After all, advance care plans ideally should be completed long before the patient reaches a six-month terminal prognosis. That’s one of the ironies in all of this. Hospice providers, who are perhaps best equipped with knowledge and experience to lead these conversations, are often not a part of the process.

But they do have a voice, and they are striving to make themselves heard through greater community engagement, public advocacy and education programs.

Hospices are providers of clinical care. They are also teachers. They are storytellers. They are accustomed to facing some of life’s most difficult questions, and they have become adept at connecting compassionately with people who greet them with fear or misperceptions.

The larger health care community can learn a lot from them, and hospices have proven willing time and again to share their wealth of knowledge.

One final note: If I am going to call out the health care system, I must likewise hold myself accountable.

I do not have an advance care plan. Like the health care system, I can do better, and this morning I contacted my primary care physician to get the ball rolling.

I am not elderly, nor do I have a serious or terminal illness. But that’s the point, we have to confront these decisions long before those factors come into play.

I urge others in my shoes to do the same, because the right time to prepare is always now.