Advance Care Planning

What is advance care planning?

Advance care planning (ACP) offers people the opportunity to plan their future care and support, including medical treatment, while they have the capacity to do so.

It involves planning and discussion about future care between the person making the ACP, their family and their healthcare professionals. and is a voluntary process.

Advance care planning can make the difference between a future where a person makes their own decisions and a future where others make decisions for them.

"It seems we have failed to recognise that people have priorities they want us to serve, besides just living longer. It seems obvious… Well, the second important lesson I learnt was that the most reliable way to learn what peoples’ priorities are – and there are highly technical studies on this - the most reliable way to learn is to ask … and we don’t ask!"

Atul Gwande. The Reith Lectures 2014, Lecture 3: The Problem of Hubris, BBC Radio

What does advance care planning involve?

Advance care planning involves anything about a person’s future care and wishes, including:

  • How they would like to be looked after
  • Where they would like to be looked after – preferred place of care and preferred place of death
  • Any spiritual or religious belief they would like taking into account
  • Who should know about their wishes and preferences
  • Practical matters – the care of pets, finances or funeral arrangements
  • What a person does not want to happen to them if they are unable to make decisions.

Knowing about a person’s wishes can make it easier for family, friends and health care professionals.

How do you make an advance care plan?

A person can talk to a healthcare professional (GP, district nurse, specialist nurse, social worker and hospital doctor), family and friends.

They can write their wishes down, but don’t have to. Writing wishes down can make it easier for people to follow the plan in the future.

Or a person can choose to plan ahead in three ways:

  • By making an Advance Care Plan of their preference and wishes for future care
  • Creating a Lasting Power of Attorney (LPA) where a person is appointed to make decisions on their behalf
  • Making an Advance Decision to Refuse Treatment (ADRT) where decisions are recorded about the treatments a person does not want to have in the future.

Who should start the process of advance care planning?

Advance care planning can be started by anyone, at any time, by the person, their family, a carer or a health or social care professional.

It should be offered when a person is well enough to participate in the discussions and before any loss of mental capacity.

What are the benefits of advance care planning?

An ACP conversation allows everyone to develop an understanding of a person’s future needs and wishes.

Evidence suggests that having discussions in relation to future treatment and care results in:

  • An increased sense of control for the person
  • Opens up conversations about making a will and funeral planning
  • Allows for proactive decision making and a reduction in the number of hospital admissions
  • More people dying in their preferred place of care which improves end of life care
  • Enables better communication between the patient, their family and health care professionals
  • Helps families prepare for the death of a loved one

For example, if you have an illness that could not be cured and your condition suddenly got worse you may want to be cared for at home. If your family, friends and healthcare team do not know this and you became too unwell to tell them, you may be taken to hospital.

Starting a conversation about planning ahead can feel difficult so it is helpful to involve people who are close to you like family and friends. They may be able to help you think through some of the issues, so you can plan ahead better.

Useful information

We have provided links below to some blank templates which you may find helpful when you are discussing and documenting an advance care plan. They can downloaded from these websites for use.

Marie Curie

Planning ahead – thinking about your care and wishes ahead of time

The Gold Standards Framework

Advance Care Planning in 5 simple steps

Macmillan Cancer Support

Advance Care Planning information and documentation for:

  • Planning Ahead
  • Your wishes for care
  • Lasting power of attorney
  • Advance directive
  • Advance decision to refuse treatment.

The Advance Care Planning facilitator at The Clatterbridge Cancer Centre is Claire Cadwallader, Palliative Care Clinical Nurse Specialist, who can be contacted via The medical lead is Dr Dan Monnery, Consultant in Palliative Medicine.