Unit 4: Advance care planning discussions

• Check before the meeting whether the individual already has an advance care plan in place and/or has discussed this with those important to them. If so, this should form the basis of your discussion to ensure a personalised approach to shared decision making.
• It is also important to encourage the individual involved to have an advance care planning discussion with those important to them before the meeting. You could signpost to the section for individuals receiving care and those important to them within this resource or suggest they consider some of the topics covered in Unit 3.
• The following ‘Planning Ahead’ tool from Hospice UK may help individuals to start thinking about these issues and what is important to them.

• Introduce the purpose of the discussion
• Discuss with the individual and those important to them whether they know what an advance care plan is, and why it is important. Some people may be confused by this term, so it is important to clarify what advance care planning is using language they are likely to understand. Issues around finding the words for advanced care planning discussions are covered in Unit 6.
• Establish and agree upon ground rules for the meeting, emphasising that all comments and viewpoints will be acknowledged and respected. Indicate the length of the meeting – up to 60 minutes is usually sufficient.
• Offer the opportunity for any questions or points of clarity.

• Outline and confirm the purpose of the meeting, which is to support the individual and those important to them to discuss wishes and preferences for care to enable a personalised future care plan to be completed. (If possible, the plan should be written-up following conversation rather than during so you can focus on facilitating the discussion).
• Identify any concerns or questions that the individual or family / carers may have – prioritise these and confirm which can be dealt with at the meeting.
• Clarify if any specific decisions need to be made.

• Has the individual previously considered their own preferences and wishes and have these been shared with anyone?
• If an advance care plan is already in place, ensure this forms the basis of the conversation and consider if this needs to be reviewed.
• If necessary, provide further information on the individual’s current plan of care.

• Talk through each component outlined in Unit 3 of this resource as necessary and provide information and support to allow the individual to make informed decisions about each area at a pace tailored to their needs.
• Remember – advance care planning can involve a series of discussions.
• During the discussion, check in with the individual and those important to them to see whether the discussion is valuable and is meeting their needs.
• If necessary, consider taking a short break to give those present time to digest information, and then allow some time to re-focus.

• Summarise the discussion and check understanding.
• Offer another opportunity for questions, comments, and concerns – signpost to other resources they can look at for further information.
• Check consent to share information to identify from the individual who information can be shared with and ensure this is recorded.
• Record the advance care plan and share decisions – the process for this is outlined in Unit 5.

For example, an individual’s spiritual beliefs may have an impact on their views towards use of life-sustaining treatments or the use of sedation towards the end of life.

There may also be cultural variations on the importance of family centred decision-making versus individual decision-making which may influence the role of the family / carers in end-of-life care and decision-making.

Cultural or language differences can lead to misunderstandings about the purpose of advance care planning. Therefore, you may need to make sure that someone is able to act as an interpreter (ideally not a family member) in advance care planning conversations, and to take time to check the individual’s understanding of their condition and of the possible options available to them. If an interpreter is not available, technologies such as Google Translate and Google Lens may offer a useful aid to support translation of ACP information into other languages.

It is not appropriate to make assumptions about approaches towards advance care planning based on an individual’s ethnicity, cultural or spiritual background, sexual orientation or identity. Advance care planning is individualised approach which aims to avoid assumptions and generalisations of any kind. The most important things are awareness of the need for cultural sensitivity, flexibility and listening; and seeking further advice and support if necessary.

Family structures are diverse. Individuals in LGBTQ+ relationships need to be included in decision-making in the same way as heterosexual partners. Ensure that you do not make assumptions about the nature of a relationship.

Ensure the needs of everyone are considered during conversations –provide access to any necessary communication support including communication aids, specialist speech and language support and involvement from those important to the individual.