Intended for healthcare professionals


Reassessing advance care planning in the light of covid-19

BMJ 2020; 369 doi: (Published 18 May 2020) Cite this as: BMJ 2020;369:m1927

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  1. Sarah A Hopkins, geriatric medicine registrar,
  2. Roberta Lovick, patient and carer representative,
  3. Louisa Polak, visiting researcher,
  4. Ben Bowers, doctoral student,
  5. Tessa Morgan, doctoral student,
  6. Michael P Kelly, senior visiting fellow,
  7. Stephen Barclay, academic general practitioner
  1. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  1. Correspondence to: S A Hopkins saah2{at}

Focus on creating a shared narrative not recording choices

Compared with younger people, older people and those with frailty are more likely to die from acute infections, such as covid-19, and less likely to survive intensive care.12 This has prompted calls internationally for advance care planning in these vulnerable populations, focusing on documenting individuals’ preferences for resuscitation and hospital admission.34 We suggest that the benefits of advance care planning derive more from its process than from the plans it produces, and that recognising this is essential for provision of optimum care for patients and their families. Moreover, an overemphasis on achieving individual choice, the stated purpose of advance care plans, may paradoxically undermine good care.5

Process versus product

Covid-19 guidance on advance care planning has largely focused on its product: a plan recording an individual’s treatment preferences.34 Yet evidence suggests that some of the main benefits that frail patients and their loved ones experience from advance care planning are strengthened relationships with each other and their clinical teams, and support through the experiences of living and dying with frailty and bereavement.6789 These benefits come largely from the conversations …

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