dvance Care Planning (ACP) serves as a critical tool for improving end-of-life quality, yet its implementation faces stage-specific challenges driven by cognitive biases. This study aims to analyze the core dilemmas encountered across the three phases of ACP—initiation, execution, and sustainability—and to develop a nudge-based intervention framework to optimize its implementation pathway. Using literature review and theoretical analysis, the study identifies key biases at each stage: avoidance of dialogue due to availability bias in the initial phase, deviation in decision-making caused by anchoring effects in the mid-term phase, and difficulties in sustainability resulting from endowment effects in the later phase. Correspondingly, a multidimensional nudge strategy framework is proposed: applying default options and process simplification (practicality and incentivization) to lower initiation barriers; utilizing framing effects and normative guidance (standardization and warning) to correct cognitive deviations; and leveraging scenario simulation and pathway comparison (predictability and comparability) to foster long-term consensus. Future ACP promotion should emphasize precise alignment between strategies and cognitive mechanisms, supported by enhanced institutional safeguards.