2.8 Describe how personal beliefs and attitudes can affect participation in the advance care planning process

This guide will help you answer 2.8 Describe how personal beliefs and attitudes can affect participation in the advance care planning process.

Advance care planning (ACP) is the process where a person makes decisions about their future health and social care. This includes discussing and recording their preferences, values, and wishes. It is often used when a person has a long-term condition, a progressive illness, or later in life when future care decisions might be needed.

Personal beliefs and attitudes can strongly affect how people take part in ACP. These factors influence whether a person feels able, willing, or ready to discuss and record their future care needs.

What are Personal Beliefs?

Personal beliefs are the ideas and values a person holds to be true. These beliefs can be shaped by factors such as culture, religion, upbringing, experiences, and personal philosophy. In ACP, personal beliefs can guide how a person views illness, dying, treatment, and independence.

For example, someone who believes that life should be preserved at all costs may want all possible medical interventions, even if recovery is unlikely. Another person may believe that quality of life is more important and may refuse certain treatments that could prolong life but also cause suffering.

What are Attitudes?

Attitudes are how a person feels about a subject or situation. These are shaped by beliefs, experiences, and emotions. Attitudes can be positive, negative, open, or resistant.

A person with a positive attitude towards discussing future care may find ACP reassuring. They may view it as a way to maintain control and dignity. Someone with a negative attitude may avoid any discussion about future care. They may see it as a sign of giving up or may feel it is too upsetting.

Cultural and Religious Beliefs

Culture and religion often influence personal beliefs about health, treatment, and death. These can directly affect ACP participation.

Examples include:

• Some faiths see life as sacred and may discourage any refusal of life-prolonging treatment.
• Certain belief systems stress acceptance of death as part of a natural cycle and may be more open to palliative care.
• Cultural norms may place decision-making in the hands of family members rather than the individual.
• Some communities may avoid speaking about death, viewing it as unlucky or disrespectful.

These beliefs can either support or limit ACP discussions.

Past Experiences with Illness and Care

A person’s own health history or experiences of seeing friends or family members receive care can affect their attitude towards ACP.

Someone who has seen poor end-of-life care may be more eager to plan their own future care. Another person who has had a traumatic health experience may avoid the topic because it triggers distress. Positive care experiences often make a person more open to planning.

Level of Trust in Health and Social Care Services

Trust plays an important role in ACP participation. If a person trusts that professionals will respect their wishes, they may be more willing to record them. If they have doubts about the system or feel that their wishes could be ignored, they may see ACP as pointless.

Trust can be influenced by:

• Past experiences with professionals
• Perception of fairness and respect in services
• Fear of discrimination
• Belief that services are overworked or under-resourced

Without trust, some people may avoid formal ACP discussions.

Emotional Factors

Talking about future illness, decline, or death can be distressing. A person’s readiness to have these conversations depends on their emotional outlook.

People may feel:

• Fear of losing independence
• Sadness about their health changes
• Anger about their condition
• Relief that their wishes can be made clear
• Anxiety about upsetting family members

These emotions can either encourage or block ACP engagement.

Communication Style and Openness

Some people are naturally open to discussing personal feelings and planning ahead. Others find these topics private and feel uncomfortable sharing them with others, even with professionals.

Communication barriers can arise if:

• The person does not feel understood
• There is a language difference
• They fear being judged
• They think staff will not respect their beliefs

Professionals need to adapt their communication approach to encourage participation.

Family Influence

Family beliefs and expectations can strengthen or weaken a person’s willingness to take part in ACP. In some families, decisions are shared and openly discussed. In others, health issues are not talked about.

Possible effects include:

• Family members encouraging ACP to avoid future disagreements
• Pressure from relatives to make certain choices
• Feeling of loyalty stopping the person from making decisions that conflict with family values
• Worry about upsetting loved ones with wishes that differ from theirs

Family attitudes can have as much influence as the individual’s own beliefs.

Perceptions of Control and Independence

ACP is often linked to a person’s wish to have control over their care. People who value self-determination may be more active in ACP. Others may see these decisions as something for doctors or family to decide.

If a person believes that their care will happen without their input, they may see no reason to plan. If they believe ACP can give them a say in their own treatment, they are more likely to engage.

Personal Health Beliefs

A person’s view on health, illness prevention, and treatment can shape their involvement in ACP.

For example:

• Someone who believes in natural remedies may prefer to avoid hospital treatments.
• A person with strong faith in medical technology may choose every possible medical intervention.
• Those with a belief in fate may feel that planning is unnecessary.

These views can influence choices about life-sustaining treatment, organ donation, hospital admission, and place of death.

Impact of Age and Life Stage

A younger person may feel that ACP is not relevant to them. An older person or someone living with a serious illness may see ACP as more important.

However, age is not the only factor. Life stage, responsibilities, and personal priorities can influence how a person views ACP. For instance, someone with young children may focus on plans that protect their family’s future, while someone living alone may focus on personal comfort and quality of life.

Stigma and Misunderstanding

Some people view ACP as only for those who are dying. This misunderstanding can reduce participation. Others may fear that writing down their wishes will limit their care or make professionals give up on them.

Clear explanations can reduce stigma and help people see ACP as a process to support their choices, not restrict them.

Differences in Decision-Making Styles

People differ in how they make decisions:

• Some gather information and think carefully before deciding.
• Others prefer quick choices based on instinct or faith.
• Some leave decisions to trusted others without looking at all the options themselves.

A person’s decision-making style, shaped by beliefs and attitudes, influences their involvement in ACP discussions.

Role of Professionals in Recognising Beliefs and Attitudes

Health and social care workers must notice and respect the beliefs and attitudes that affect ACP. This includes active listening, observing body language, and being sensitive to cultural signals.

Workers can support participation by:

• Taking time to understand personal values
• Using clear, accessible language
• Involving family or community representatives if the person wants
• Allowing enough time for decision-making
• Avoiding pressure and respecting a person’s choice not to take part at that time

Encouraging Balanced Decisions

Beliefs and attitudes are personal, but they can sometimes limit a person’s ability to consider all options. For example, someone with a strong fear of hospitals may refuse discussion about inpatient care, even if it could improve quality of life.

Professionals can encourage participation by:

• Exploring the reasons behind decisions without judgement
• Providing accurate information about care options
• Clarifying that wishes can be reviewed and changed
• Showing respect for all views, even if they differ from professional opinion

Ethical Considerations

Respecting beliefs and attitudes is part of providing person-centred care. Professionals need to balance respect for autonomy with safeguarding and legal responsibilities.

Ethical practice means:

• Not imposing personal views on the person
• Protecting the right to make choices, even when those choices involve some risk
• Supporting informed decision-making
• Maintaining dignity and privacy in all discussions

Final Thoughts

Personal beliefs and attitudes have a strong influence on a person’s willingness to take part in advance care planning. These influences can come from culture, religion, past experiences, emotional state, family expectations, and trust in services. They shape how the person views illness, treatment, and end-of-life care.

Health and social care workers play a key role in recognising and respecting these influences. By creating a safe, respectful, and clear environment, workers can help people feel confident about discussing their wishes. Participation in ACP should always be offered, but it must never be forced. The best outcomes happen when the process reflects the unique beliefs and attitudes of the individual.