Starting the conversation: why advance care planning matters

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By Dr Catherine Joyce, National Manager, Advance Care Planning Australia and Kylie Ash, Education Coordinator, Advance Care Planning Australia

As your patient’s needs become more complex or span multiple services and providers, understanding what matters most to them is essential for delivering coordinated, person-led care. Advance care planning helps ensure the person’s voice is heard and their values and preferences are respected throughout their care journey.

When and how should you have a conversation with your patients about advance care planning?

Your role as a health professional includes explaining what advance care planning is, explaining the benefits, and encouraging people to engage. Advance care planning is an ongoing and voluntary process, so you don’t have to do everything at once. Providing information and getting the conversation started are important steps.

You could start by explaining:

• Advance care planning is about planning for your future health care, in case there comes a time when you can’t speak for yourself.
• It’s about what matters to you: your beliefs, values, preferences; what outcomes you would or wouldn’t want.
• It can include who you want to make decisions for you if you’re not able to do so yourself.

You can also explain:

• It helps make sure your voice is heard even when you can’t speak for yourself. This can help avoid treatments you would not have wanted.
• It can give you peace of mind knowing that things are taken care of.
• It can ease the burden for your family, reducing distress and uncertainty and giving them confidence to make decisions with a clear understanding of what you would have wanted.

Our recent research shows that the majority of people – three out of four – are open to talking about advance care planning, and that many people look to their health professionals to support them with the process. Health professionals should never assume that someone else has raised the topic. Think of this as an opportunity to develop deeper understanding of your patient.

Advance care planning can raise big questions for people, so it’s useful to start the conversation early, when the person is stable and not in crisis. It’s never too early, but it can be too late.

Good times to introduce advance care planning or review their goals and preferences include:

• when a patient or family member asks about current or future treatment goals
• during health assessments or routine check-ups, such as annual flu vaccinations
• following diagnoses that suggest a poorer prognosis, like metastatic cancer or organ failure
• if you wouldn’t be surprised if the patient died within twelve months
• when care arrangements are changing, such as moving into residential aged care.

Advance care planning is particularly relevant if the person:

• has advanced chronic or life-limiting illness
• is aged 75 or older, or 55 or older if Aboriginal and/or Torres Strait Islander
• has had a recent significant diagnosis or is at a turning point in their illness
• lacks a clear substitute decision-maker
• is likely to die in the next year.

Language matters. The way we start and frame these conversations can make a real difference. A patient and empathetic approach, which presents advance care planning as part of routine care, is important. Some helpful phrases include:

• ‘I try to talk to all my patients about what they would want if they became more unwell. Have you ever thought about this?’
• ‘Who would you like me to talk to if you were unable to speak for yourself?’
• ‘What does living well mean to you? What are your goals right now?’
• ‘What do you understand about your illness and where things are at?’
• ‘Thank you for sharing what’s important to you. Do your family or carers know your wishes?’

These conversations are vital. They help align care with what matters most to the individual – and reduce stress for families and care teams at critical moments.

To learn more, try the Advance Care Planning Australia microlearning campaigns. Learn about advance care planning and starting and continuing advance care planning conversations.

To build your skills further, explore the updated Coordinating Patient Care module at End-of-Life Essentials.

 

Dr Catherine Joyce

National Manager, Advance Care Planning Australia

 

 

 

Kylie Ash

Education Coordinator, Advance Care Planning Australia