Advance Care Planning (2018)


A lack of consensus regarding the definition of advance care planning (ACP), and a lack of practice recommendations that are applicable to a variety of cultural settings and personal values, have hindered the development of ACP programmes and the evaluation of ACP’s effectiveness.

We aimed to develop a consensus definition of ACP and present recommendations for ACP that can be used by health-care providers, policy makers, and researchers across a broad spectrum of patient populations, disease categories, and cultures.

Healthcare workers, researchers, policy makers, patients, relatives

Five round Delphi study including literature reviews.

Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68–100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate.

Recommendations included the adaptation of ACP based on the readiness of the individual; targeting ACP content as the individual’s health condition worsens; and, using trained non-physician facilitators to support the ACP process. We present a list of outcome measures to enable the pooling and comparison of results of ACP studies. We believe that our recommendations can provide guidance for clinical practice, ACP policy, and research.

Links and Resources

Download the full text of the article from The Lancet Oncology. DOI: (You or your institution need a subscription to download the full-text article).

Download a copy of the draft paper here 

Download Italian version here

Download Dutch version here

Read more posts about advance care planning on the EAPC Blog.

ACTION project:

EAPC White Paper: Defining optimal palliative care in older people with dementia

Recommendations on palliative care and treatment of older people with Alzheimer’s disease and other progressive dementias: The 11 domains and 57 recommendations including explanatory text:

Arabic version

Croatian version

Dutch version

English version

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