How should I approach discussions about advance care planning with patients nearing the end of life?

Approach discussions about advance care planning (ACP) with sensitivity and respect for the patient's preferences. Recognise that some patients may prefer not to discuss ACP or may want to postpone the conversation, and be prepared to revisit the topic later if needed.

Ensure the conversation occurs within a trusting and collaborative relationship, providing clear, accessible verbal and written information tailored to the patient's condition and circumstances. This includes explaining the purpose, advantages, and challenges of ACP, and how decisions can be changed while the patient retains capacity.

Identify and accommodate the patient's communication needs and preferences, including involving carers, family, or advocates if the patient consents. Use communication aids or specialist support as appropriate to help the patient participate fully.

Discuss the patient's prognosis openly and honestly, unless they prefer not to be informed, and include those important to them if the patient agrees. Provide accurate information about their condition and what to expect, allowing opportunities to ask questions and express fears or anxieties.

Explore the patient's values, wishes, beliefs (including cultural, religious, and ethnic factors), and any advance statements or decisions they have already made. Help them anticipate how their needs may change in the future.

Document the ACP contemporaneously, agree the notes with the patient, and seek consent to share the information with relevant parties. Provide the patient with an accessible document recording their preferences, which they can share with different services.

Ensure that ACP discussions are offered at suitable times, such as after diagnosis of a life-limiting condition and at other times to allow reflection. Support the patient to make an informed choice about participating in ACP and enable them to do so if they wish.