Advance and future care planning

Patients, relatives, and healthcare professionals recognise the value of pre-emptive consideration and documentation of what treatments might be wanted and beneficial in an emergency. In the past, the most common advance planning documentation was a “do not attempt cardiopulmonary resuscitation” (DNACPR) notice. These communicate that one specific treatment—cardiopulmonary resuscitation (CPR)—should not be attempted,1 often without contextualising this decision within overall goals of care.2 A growing recognition of the importance of respecting patient autonomy3 has contributed to a shift towards more patient centred conversations and increasing integration of patient values and wishes into the decision making process.24 However, this process of shared decision making continues to be often initiated only at the point of serious illness and focused on specific treatments.1

Patients and healthcare professionals can use many different tools to make sure that future treatment aligns with a patient’s wishes. All these tools fall under the umbrella of advance (or future or anticipatory) care planning5 but vary in who leads them and whether they focus on specific treatments or goals of care. These tools are summarised in table 1. This article outlines the different forms of advance care planning available to patients and clinicians and answers many of the common questions that arise around advance care planning.