Clinical Review

An introduction to advance care planning in practice

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6064 (Published 21 October 2013) Cite this as: BMJ 2013;347:f6064
  1. Anjali Mullick, consultant in palliative medicine12,
  2. Jonathan Martin, consultant in palliative medicine and visiting fellow13,
  3. Libby Sallnow, specialty registrar in palliative medicine and research fellow1
  1. 1St Joseph’s Hospice, London E8 4SA, UK
  2. 2Newham University Hospital, London, UK
  3. 3Harris Manchester College, University of Oxford, Oxford, UK
  1. Correspondence to: A Mullick a.mullick{at}stjh.org.uk
  • Accepted 7 October 2013

Summary points

  • Advance care planning aims to help patients establish decisions about future care that take effect when they lose capacity

  • Evidence for the benefit of advance care planning is mixed; more recent evidence suggests that it can facilitate the delivery of care more in keeping with patient wishes and increase patient and family satisfaction with care

  • Advance care planning discussions should be centred around the beliefs, goals, and values of patients, rather than on specific outcomes or interventions

  • A sound working knowledge of the Mental Capacity Act 2005 is important when facilitating advance care plan discussions

Advance care planning has been defined as a process of formal decision making that aims to help patients establish decisions about future care that take effect when they lose capacity.1 It recently gained increased importance in the United Kingdom, after being recommended by the end of life care strategy.2 The first national guidance for health and social care staff in the UK was produced in 2007 and revised in 2011.3 Before this, terms and concepts used in the UK had included “living wills” and “advance directives,” which have been replaced by terminology outlined in the national guidance and the Mental Capacity Act 2005.4

Advance care planning differs from general care planning in that it is usually used in the context of progressive illness and anticipated deterioration. This has implications for its acceptability to patients. It is a voluntary process and may result in a written record of a patient’s wishes, which can be referred to by carers and health professionals in the future. If a patient loses capacity, health and social care professionals should make use of information gleaned from the advance care planning process to guide them in decision making when needed.

The Royal College of Physicians and other national …

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