Advance Care Planning conversations: What constitutes best practice and the way forward

Abstract

Background: Advance Care Planning (ACP) conversations are a cornerstone of modern health care and need to be supported. However, research indicates that the uptake thereof is limited, regardless of various campaigns. ACP conversations are complex and specific elements thereof should be discussed at various timepoints during the illness trajectory. Objective: This narrative review delineates what ACP conversation should entail, and a way forward. Methods: A PEO (Population, Exposure, Outcome) search was performed using relevant keywords, and 615 articles were identified. Through screening and coding, this number was reduced to 24 articles. All the authors were involved in the final selection of the articles. Results: Various themes developed throughout the review which include timing early on in the disease trajectory; incorporating beliefs and culturally relevant contexts; conversations needing to be iterative and short; involving surrogates and family; applying various media formats. Discussion: ACP conversations are relevant. ACP is not static and needs to be dynamic as patients’ illness trajectories and goals change. The care team needs to guard themselves against having ACP conversations to satisfy a metric and should instead be guided by the patient’s expressed values and wishes. A systemwide operational plan will help alleviate common barriers in having appropriate ACP conversations.