2.1 Explain when advance care planning may be introduced

This guide will help you answer 2.1 Explain when advance care planning may be introduced.

Advance care planning is a voluntary process that allows a person to make decisions about their future health and social care. These decisions can be used if, in the future, the person becomes unable to communicate or make informed choices. It often involves discussions with family members, carers, and professionals such as doctors, nurses, and social workers.

The aim of advance care planning is to make sure that a person’s wishes and preferences are respected when they cannot speak for themselves. It is a person-led process, meaning it should be based around their values, beliefs, and individual choices.

Understanding when advance care planning may be introduced is important for health and social care workers. This ensures that conversations happen at the right time and that support is offered appropriately.

Early Diagnosis of a Life-Limiting Condition

Many people may be introduced to advance care planning soon after receiving a diagnosis of a life-limiting condition. This may include illnesses such as advanced cancer, motor neurone disease, or chronic obstructive pulmonary disease.

In these situations, the person might still be well enough to think clearly and express themselves. Introducing advance care planning at this point gives them control over decisions about treatments, preferred place of care, and end-of-life wishes.

Reasons for introducing it at this stage include:

• The person has time to consider options without feeling rushed
• They can discuss choices openly with family and professionals
• It allows them to prepare emotionally and practically

Starting these conversations early can prevent distress later, when making decisions may be more difficult.

Following Noticeable Decline in Health

Advance care planning can be introduced when a person’s health or abilities begin to decline in a way that suggests they may struggle to communicate in the future. This might include worsening symptoms, increasing hospital admissions, or progressive frailty in older people.

In these cases, the introduction of advance care planning helps identify any support or equipment they may need. It also means the person can express wishes about treatments they do or do not want, such as resuscitation or artificial feeding.

Indicators that the time may be right include:

• Significant loss of weight or strength
• Increased reliance on care support
• Repeated infections or long recovery times
• Loss of interest in previously enjoyed activities

Health and social care staff should be alert to these changes and offer gentle, respectful opportunities for discussion.

When Cognitive Decline Is Likely or Beginning

Cognitive decline refers to the loss of thinking skills, memory, and decision-making ability. Conditions such as dementia can cause this decline over months or years.

Advance care planning is best introduced when the person is still able to fully participate in decisions, even if early signs of memory problems are present. If left too late, the person may lack the mental capacity to express wishes, meaning others will have to decide on their behalf.

Examples of early signs that may trigger the introduction of planning include:

• Forgetting recent events or conversations
• Difficulty following steps in a task
• Struggling with familiar names or faces
• Becoming easily confused in new situations

Introducing planning early allows the person’s voice to remain central in all care decisions.

After an Unexpected Health Crisis

Some people may not have thought about advance care planning until they experience a sudden illness or emergency admission to hospital. This could be a heart attack, severe stroke, or major accident.

Once the immediate health crisis is under control and the person is stable, a care professional may suggest advance care planning. This ensures that if another crisis happens, there is clarity about what the person would want.

This stage is often a natural time for the conversation, because the sudden event may highlight the unpredictability of health.

During Major Changes to Living Arrangements

Advance care planning can be introduced when a person moves into a care home, supported housing, or another long-term care setting.

These moves often signal a time when health care needs have increased. Having conversations about preferences helps staff provide care in a way that matches the person’s values and beliefs.

This can include:

• How they feel about hospital admission if they become more unwell
• Choices about life-prolonging treatments
• Preferred location for care and support in final stages of life

Talking at this stage can make new living arrangements feel more secure and respectful.

When Recommended by a Health Professional

Sometimes a health professional may see signs that suggest it is the right time to talk about future planning. This might be raised by a GP, nurse, or specialist, based on their medical knowledge and experience.

Professionals may suggest the conversation when they think a condition is progressing or when treatment options are changing. This approach is often based on their awareness of how health is likely to change over time.

Trust between the person and the professional is important for these conversations to feel safe.

When the Person Requests It

Advance care planning can begin any time a person chooses to talk about their future health and care needs. Some people feel strongly about planning ahead, even when they are currently healthy.

A person may be prompted by:

• The illness or death of a friend or relative
• Public awareness campaigns about planning for the future
• Personal beliefs about independence and choice

If someone expresses interest in making an advance care plan, staff should respond promptly and put arrangements in place for a supported conversation.

National Guidelines and Best Practice Timing

In the UK, organisations such as the NHS and the National Institute for Health and Care Excellence provide guidance on advance care planning. They encourage starting conversations early, especially for anyone with a progressive illness.

Best practice suggests that planning is most effective when the person is not under severe stress, is able to understand options, and has the time to discuss them in detail with those they trust.

Good timing means the person:

• Can weigh up the risks and benefits of treatments
• Can record clear, informed decisions
• Feels in control rather than pressured

Factors Affecting the Timing

The right time for introducing advance care planning varies. Factors that can influence timing include:

• The stage and speed of illness progression
• The person’s readiness to talk about future care
• Cultural or religious attitudes towards discussions about illness and death
• Family relationships and dynamics
• The presence of a supportive environment for decision-making

Workers should always assess the individual situation and offer rather than force the conversation.

Sensitivity in Introducing Advance Care Planning

How the topic is raised is just as important as when it is introduced. Timing must be paired with sensitivity and respect.

Approaches when introducing planning:

• Choose a private and calm setting
• Allow plenty of time for discussion without rushing
• Use clear, plain language free from medical jargon
• Listen actively and acknowledge feelings
• Offer written information to support the conversation

If the person is not ready to discuss, it is better to revisit the idea later rather than pressuring them.

Recording and Reviewing the Plan

Once advance care planning has been introduced and discussed, it should be written down to make it available for health and social care teams. People can change their mind at any time, so it is important to revisit and review the plan regularly.

Review may be needed if:

• The person’s medical condition changes
• New treatments become available
• There are changes to living situations or relationships

Advance care plans are most effective when they are kept up to date and shared with everyone who needs to know.

Barriers to Early Introduction

Some reasons why advance care planning might be delayed include:

• The person not feeling ready to discuss their own illness or death
• Families finding the topic upsetting or wanting to protect the person from distress
• Lack of time in busy care settings
• Professionals not feeling confident in starting the conversation
• Cultural beliefs that discourage future planning for illness

Awareness of these barriers can help workers find strategies to introduce planning with greater success.

Role of Health and Social Care Workers

Workers have an important part in recognising the right time to introduce advance care planning. They may not lead the medical discussion, but they are often the first to notice changes that signal it may be appropriate.

This includes:

• Observing decline in health, wellbeing, or mobility
• Listening for comments about future worries
• Informing the wider care team about changes
• Supporting the person to access advice and guidance

Workers can also be a reassuring presence during discussions, helping translate information and offering emotional support.

Final Thoughts

Advance care planning is a respectful way of making sure a person’s future care reflects their choices. The timing of when it is introduced can greatly influence how comfortable and effective the process feels. By starting the conversation early enough, the person has the best chance to express their wishes with clarity and confidence.

In health and social care, the right timing may follow diagnosis of a life-limiting condition, noticeable decline, or a direct request by the person. It might come after a health crisis, during changes in living arrangements, or on the advice of a trusted professional. Being aware of these triggers and taking a sensitive approach ensures that the conversation is timely, respectful, and meaningful.

By thinking carefully about when to introduce advance care planning, workers can support better quality of life, reduced stress, and care decisions that truly reflect the person’s values. This makes a significant difference to both the person and those who care for them.