In 2017, the National Center for Ethics set up multidisciplinary advisory boards at the local level to enhance the discussion and implementation of End-of-life choices. They also created national templates. Prior to this, locally created code status notes were used. Different service lines documented code status differently. There was limited documentation of communication. Since then, there has been ongoing education and encouragement to complete Life Sustaining Treatment Initiative notes. Initially, there was an increase in notes written (FY19: 228, FY18: 58). This then declined. From July 2024 through September 2025, the GEC providers partnered with PACT -RN to create sustainable strategies to enhance communication with patients regarding End-of-Life decisions. They also created sustainable strategies to enhance communication among the patient care teams. This was accomplished by education in having Goals of Care Conversations and completing life sustaining treatment initiative notes. This was measured by an increase (FY25: 256, FY24: 141) in the number of life sustaining treatment initiative notes by providers across the clinical departments. The number of life sustaining treatment initiative notes increased. More importantly, there was robust discussion regarding the challenges to addressing end of life choices. Medical center staff were better informed regarding the initiative. The next steps include maintaining educational programs regarding the process of having and documenting the conversation. There is also the need to assist staff in feeling confident and comfortable when addressing End-of-Life choices with veterans and their families.