Advance Care Planning (ACP) has evolved from a narrow focus on code status and advance directives to a comprehensive process that prepares patients and their surrogate decision-makers for communication and medical decision-making across the life course. This narrative review explores the evolution, innovations, and outcomes of ACP using thematic analysis of randomized controlled trials, reviews, and editorials. Key findings include: 1. **Evolution of ACP**: ACP has moved from a sole focus on code status and advance directives to a continuum of care planning focused on tailored preparation for patients and surrogates. 2. **Measurement of ACP**: ACP measurement has evolved from traditional outcome metrics like AD completion to a comprehensive framework that includes behavior change theory, systems, implementation science, and surrogate outcomes. 3. **Positive Outcomes**: High-quality trials have reported mainly positive outcomes for interventions, especially for surrogates, aligning with the patient desire to relieve decision-making burden on loved ones. 4. **Integration into EHR**: "Clinically meaningful" ACP information, including documented goals of care discussions, is increasingly integrated into electronic health records (EHRs), and real-time assessments and natural language processing enhance ACP evaluation. 5. **Practical Recommendations**: Clinicians and researchers can use and disseminate updated definitions, provide validated tools for patients, use easy-to-access clinician training, and document patients' values and preferences in the medical record to capture clinically meaningful ACP. The review emphasizes the need for future efforts to focus on efficient implementation, expanded reimbursement options, and seamless integration of EHR documentation to ensure ACP's continued evolution to better serve patients and their care partners.Advance Care Planning (ACP) has evolved from a narrow focus on code status and advance directives to a comprehensive process that prepares patients and their surrogate decision-makers for communication and medical decision-making across the life course. This narrative review explores the evolution, innovations, and outcomes of ACP using thematic analysis of randomized controlled trials, reviews, and editorials. Key findings include: 1. **Evolution of ACP**: ACP has moved from a sole focus on code status and advance directives to a continuum of care planning focused on tailored preparation for patients and surrogates. 2. **Measurement of ACP**: ACP measurement has evolved from traditional outcome metrics like AD completion to a comprehensive framework that includes behavior change theory, systems, implementation science, and surrogate outcomes. 3. **Positive Outcomes**: High-quality trials have reported mainly positive outcomes for interventions, especially for surrogates, aligning with the patient desire to relieve decision-making burden on loved ones. 4. **Integration into EHR**: "Clinically meaningful" ACP information, including documented goals of care discussions, is increasingly integrated into electronic health records (EHRs), and real-time assessments and natural language processing enhance ACP evaluation. 5. **Practical Recommendations**: Clinicians and researchers can use and disseminate updated definitions, provide validated tools for patients, use easy-to-access clinician training, and document patients' values and preferences in the medical record to capture clinically meaningful ACP. The review emphasizes the need for future efforts to focus on efficient implementation, expanded reimbursement options, and seamless integration of EHR documentation to ensure ACP's continued evolution to better serve patients and their care partners.