End-of-life care and its planning by individuals, in concert with their families and professional healthcare givers, pose important social, legal, and ethical issues. The authors evaluate the results of a multi-year (1991-2001) collaborative effort among representatives of Georgia healthcare providers, healthcare payers, and the general public that was designed to improve end-of-life care through community-focused field effort to increase public awareness, execution, and institutional maangement of advance directives and impact institutional and state government systems and policies around end-of-life care.