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Background: Most seriously ill older adults visit the emergency department (ED) near the end of life, yet no feasible method exists to empower them to formulate their care goals in this setting.

Objective: To develop an intervention to empower seriously ill older adults to formulate their future care goals in the ED.

Design: Prospective intervention development study.

Setting: In a single, urban, academic ED, we refined the prototype intervention with ED clinicians and patient advisors. We tested the intervention for its acceptability in English-speaking patients ≥65 years old with serious illness or patients whose treating ED clinician answered “No” to the “surprise question” (“would not be surprised if died in the next 12 months”). We excluded patients with advance directives or whose treating ED clinician determined the patient to be inappropriate.

Measurements: Our primary outcome was perceived acceptability of our …