Advance care planning (ACP) enables people to articulate and record their preferences for future care. This supports person-centred care and may reduce inappropriate hospital admissions and invasive, often futile, interventions.

The study published in Palliative Medicine on barriers and enablers in ACP is essential reading for all who care for older people, those with early dementia and those with a life-limiting condition. Key barriers identified were that ACP was unclear, in terms of meaning and the language used. Older people found a lack of relevance preferring to focus on living well now. The importance of family, relationships and home, and the influence of relationship on end of life decision-making were important.

Two critical findings that are essential for any facilitator engaging with end-of-life care plans are again revealed. ACP requires multiple conversations and using a gentle, honest and individualised approach. These conversations start with simple but crucial issues that are currently important to the person; such as ‘what is important for you?’ or ‘ tell me what on your mind’. The language should be simple and expressions like ‘advance care planning’ should only be used after many on-going conversations. The early conversations build trust and allow the facilitator to better understand the person and family. Wherever possible family should join the conversations, the earlier the better. I have found that facilitating ACP conversations requires a great deal of listening especially the earlier conversations.

The second finding worth stressing, is that the whole process is not about documentation nor is it a medicalised process. Rather it is an attempt to understand the person’s wishes and preferences for what happens today and the many tomorrows. To understand their beliefs and values and if possible, share these with family. Documentation is important but is simply an outcome of the conversations.

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