3.1. Explain advance care planning

This guide will help you answer 3.1. Explain advance care planning.

Advance care planning (ACP) helps individuals outline their future care preferences. It ensures their wishes are known and respected if they lose the ability to make decisions later. ACP is vital for promoting autonomy, dignity, and personalised care in health and social care settings.

What is Advance Care Planning?

ACP is a voluntary process where someone discusses and records their preferences for future care and treatment. These preferences are used if they cannot communicate or make decisions for themselves due to illness, injury, or frailty. The plan may include opinions on medical treatments, personal care needs, and where the individual would like to be cared for.

ACP is not legally binding but informs care decisions. It often complements formal legal documents, such as a lasting power of attorney (LPA) or advance decisions to refuse treatment (ADRT).

Core Elements of Advance Care Planning

ACP generally includes these aspects:

• Advance Decisions to Refuse Treatment (ADRT): This is a legal document stating treatments a person does not want under specific circumstances. For example, someone may decline CPR or life-support machines if they feel such treatments would prolong suffering.
• Lasting Power of Attorney (LPA): This legally appointed person acts on behalf of the individual when they cannot make decisions. An LPA may focus on healthcare decisions or financial matters.
• Preferences for Care: These outline the individual’s wishes regarding the type of care they receive or how they want to live. For instance, they may express preferences for home care rather than hospital care or cultural needs.
• Emergency Planning: ACP may include guidance about what should happen during emergencies, such as resuscitation or transfers to a hospital.
• Do Not Attempt Cardiopulmonary Resuscitation (DNACPR): This specific instruction tells healthcare professionals that CPR is not appropriate for the person if their heart stops.

How Advance Care Planning Works

ACP discussions should be led by professionals who understand the process and support effective communication. These conversations typically follow these steps:

1. Introducing the Topic: Healthcare or social care workers sensitively explain advance care planning to the individual. Providing clear information about ACP helps avoid misunderstandings.
2. Exploring Values and Preferences: Professionals ask open-ended questions to understand the individual’s values, religious beliefs, cultural needs, and priorities. They may also help identify any fears or concerns about future care.
3. Documenting Decisions: Once preferences are expressed, they are recorded. This provides a clear, written account for the individual’s family, carers, and professionals to follow.
4. Sharing the Information: Preferably, ACP information is shared with key professionals, such as GPs, hospital staff, and care support teams. Family members or close friends may also be included to avoid conflicts in decision-making.
5. Reviewing and Updating the Plans: ACP is an ongoing process. Circumstances change, or health conditions may develop, requiring updates to ensure the plan accurately reflects the individual’s current wishes.

Benefits of Advance Care Planning

ACP has significant benefits for the individual, their families, and healthcare professionals:

• Promotes Individual Choice – ACP gives people the ability to control how their care is delivered. By discussing preferences, individuals can guide decisions that respect their values.
• Reduces Stress for Families – When individuals make their preferences clear, family members face less uncertainty about what to do in difficult situations. This prevents conflicts or guilt regarding decisions about treatment.
• Supports Personalised Care – Healthcare professionals provide personalised care based on the individual’s advance care plan. This ensures dignity and maximises quality of life.
• Prevents Unwanted Interventions – ACP can reduce the risk of unnecessary treatments that may cause physical or emotional distress. For example, someone may choose palliative care rather than life-extending interventions.

Legal and Ethical Considerations

While ACP itself is not legally binding, certain documents created during the process, like ADRT or an LPA, may hold legal weight. This ensures professionals act per the individual’s wishes.

Healthcare professionals must respect the ethical principles of autonomy—granting individuals the right to make their own decisions—and beneficence—ensuring actions are taken to benefit the person.

The Mental Capacity Act 2005 supports ACP. It provides guidelines for making decisions when someone cannot make their own. Factors include assessing whether the person can understand, retain, and weigh up options before communicating their choice. If they lack capacity, decision-makers must act in the individual’s best interest.

Challenges of Advance Care Planning

ACP involves sensitive discussions and requires careful handling to overcome possible barriers, such as:

• Emotional Distress: ACP often involves discussions about illness, death, or loss of independence. Some people may find this upsetting, while others may avoid the topic altogether.
• Lack of Awareness: People or carers may not know ACP exists or may confuse it with other processes like creating a will. Clear information from professionals addresses this.
• Disagreements Among Family: Relatives may hold opposing views on the individual’s wishes. Professionals mediate family conversations to resolve disputes.
• Assumptions About ACP: Misunderstandings about ACP’s purpose can lead to reluctance. Some people wrongly assume ACP limits their care options rather than allows them to express their wishes.

Supporting Communication in Advance Care Planning

Effective communication plays an important role in ACP discussions. Professionals need to use plain language and consider the person’s emotional state, cultural background, and communication needs.

Strategies include:

• Active Listening: Paying close attention to what the individual says and showing empathy builds trust.
• Using Visual Aids: Diagrams, videos, or written materials help explain ACP in a less intimidating way.
• Involving Advocacy Services: Advocates help individuals who struggle to express themselves verbally, ensuring their voice is heard.
• Simplifying Legal Concepts: Breaking down legal terms such as ADRT or LPA ensures people fully understand their rights and options.

Advance Care Planning and the Wider Community

ACP has positive implications for both individuals and the broader community. It encourages conversations about death and dying, helping people approach these topics with openness rather than fear.

Organisations such as hospices, care homes, and hospitals also benefit from ACP. Documented plans enable staff to deliver better, more aligned support, reducing misunderstandings, delays, and unnecessary treatments.

How Social Care Workers Contribute to ACP

Social care workers play a significant role in ACP. They build relationships with individuals, providing ongoing emotional support throughout the planning process. Many also work as advocates for individuals unable to articulate their wishes.

Key tasks for social care workers in ACP include:

• Encouraging individuals to explore their values and make informed decisions.
• Working closely with health professionals to ensure preferences are followed.
• Assisting with reviewing and updating plans as circumstances change.
• Helping families or carers understand the importance of respecting individual wishes.

Final Thoughts

Advance care planning ensures individuals’ rights and wishes are respected, even in challenging situations. It requires sensitivity, effective communication, and collaboration between professionals and families. While there are challenges, ACP provides an essential framework for delivering personalised care and upholding dignity. Through clear communication and mutual respect, advance care planning benefits everyone involved.