Advance care planning and goals of care discussions

Abstract

Advance care planning (ACP) conversations and goals of care (GOC) discussions prepare patients and their substitute decision-makers for medical decision-making. When rooted in a patient’s values and person-centred in approach, ACP and GOC discussions can optimize the likelihood a person receives care that is concordant with their goals. This chapter explores the definitions and clinical processes for ACP and GOC discussions and describes how a patient’s values and goals can directly inform medical decision-making. Differences in ACP among healthy and seriously ill individuals, common communication challenges, and the pitfalls of a treatment-centred approach are described. The chapter underscores the importance of illness understanding and provides tips on addressing prognosis. Finally, healthcare system impacts of ACP and GOC are considered.