Unit 6: Timing & Communication during Advance Care Planning Conversations

Advance care planning conversations are difficult conversations to start given the sensitive nature of the topics discussed. Karen Bowes from the Royal College of Nursing refers to advance care planning discussions as ‘courageous conversations’ recognising that whilst necessary, these are not easy conversations to initiate. There are many factors to consider when determining an appropriate time and approach to starting and managing the process of advance care planning conversations. This unit considers the importance of timing and, how using your own communication style and choice of words can assist with the process.

What events may trigger an advance care planning conversation?

Introducing the topic of advance care planning early can help prepare for more in-depth conversations as an individual’s condition progresses or encourage individuals to raise this topic themselves.

However for some individuals, deterioration in their long-term condition, a new diagnosis, hospitalisation, an emergency, or the death of someone close to them may prompt them to think about their own advance care planning.

It is important to recognise there are times when an advance care planning discussion may become imperative, for example, in an emergency. It is also important to acknowledge that whilst anyone can have an advance care plan, the process may be more pressing for others– for example, those with a progressive condition that is likely to deteriorate, older frailer adults and individuals in their final year of life.

Not everyone will be receptive to advance care planning conversation and it is important to respect this. Discussions will happen at various times and stages of the disease process. They are conversations that should be carried out over time and can be changed if necessary.

In the video below, Dr Philomena Swarbrick provides useful tips for starting advance care planning conversations.

Choice of words

When having advance care planning discussions with individuals and those important to them, your choice of words is important. Try and talk to them using language they will understand. Where possible, avoid medical or technical terms to prevent misunderstandings. This may not be an easy conversation, so it is important to be supportive and empathetic.

People may get upset when having an advance care planning discussion, but this does not necessarily mean you have done something wrong. You might find that, despite feeling upset at the time, they feel much better afterwards.

Preparing for advance care planning conversations using a structured approach will help facilitate these discussions. The RED-MAP guide described below is a 6-step approach to care planning discussions with conversational prompts that can be used in practice.

Acknowledgement: The RED-MAP resource was developed by Dr Kirsty Boyd, Macmillan Reader in Palliative Care at the University of Edinburgh, and the accompanying video was produced in collaboration with the Royal College of Physicians and Surgeons of Glasgow.

Avoiding Jargon

All health care professionals will have their own communication style, and this will vary based on the individual you are talking to. It is important to be authentic in how you communicate but try to use positive, clear language, avoiding words and terminology that may lead to confusion.

Whilst it is important to use the correct terminology, and this may include scientific or medical words or phrases, always ensure that this is followed by a clear explanation of what the word or phrase means and how it relates to the advance care planning process. The glossary of terms provides a definition of the key terms discussed during the advance care planning process.

Finding your own words & approach to advance care planning

Good communication skills such as active listening are important for noticing cues that it’s a good time to start an advance care planning conversation and a warm, sensitive, and empathic tone will put everyone involved in the discussions at ease. Think about how you would like you or your family member to be spoken to.

Non-verbal cues

It is important to look for non-verbal cues that suggest a person is ready for an advance care planning discussion or indicates signs of unease or distress during a discussion. This may be via their eye contact, a look of concern, body movement such as fidgeting or a look of discomfort. If you notice any non-verbal cues, open-ended question such as ‘what are you thinking?’ or ‘how are you feeling discussing this topic’ will allow time for the individual to express how they feel and if they want to continue the discussion.

It is also important to think of your own non-verbal communication during the process, for example open body language such as a warm smile, good eye contact, and positive gestures such as nodding in agreement will suggest you are interested and receptive to a conversation about the process.

In the video below, Dr Kathryn Mannix, A Retired Palliative Care Practitioner, provides useful tips for managing the more difficult aspects of advance care planning conversations.

Summary: 10 Tips for having advance care planning discussions

View a downloadable version of the top 10 tips.