Articulating preferences

Advance care planning (ACP) is a conversation about how a person wishes to be treated under circumstances in which they are not able to speak for themselves.

Key points

The aim of advance care planning is:

  • To support patients’ autonomy and decision making
  • To prevent them from receiving unwanted treatments, and
  • To help ensure their care is consistent with their values.

Recognise that many patients expect their doctor to take the initiative in raising the topic of their preferences about future care.

An informed advance care plan requires an understanding by the patient of their own health problems, and also about the realistic implications of the possible treatment options. Legal competence and capacity should be considered.

An advance care plan may consist of:

  • a discussion between a patient and their doctor about their values and wishes (for example, 'I prefer not to have any extraordinary treatment that would prolong my dying') OR
  • the formal or informal choice of a person to be a substitute decision maker, OR
  • writing an advance care plan, OR
  • a combination of these.
The Advance Project offers a structured approach to initiating advance care planning and palliative care in general practice. Resources and online training are available. 

Each state and territory has its own local policies about ACP. Advance Care Planning Australia (ACPA) include forms for advance directives, policy documents, and information about the legal aspects of ACP for each state and territory.

Useful tip

Advance care planning can be as simple as discussing a person’s wishes and ensuring that the family or other substitute decision maker is aware of these wishes. Make sure they are noted in the clinical record.

Documentation helps ensure that an advance care plan will be respected. Australian states all have different legal frameworks, and some provide a specific document for recording advance care plans.

Even when patients have difficulty acknowledging that they may be deteriorating, or discussing poor prognosis, it is still possible to help them to make an advance care plan - in terms of planning for the 'what ifs'.

Last updated 24 August 2021