Advance Care Planning: Exploring the barriers to a universal approach to End of Life Care

Healthwatch Staffordshire, Healthwatch Walsall and Healthwatch Wolverhampton, together with partners across Staffordshire, Walsall and Wolverhampton, undertook research into Advance Care Planning (ACP) as part of a wider review of end-of-life care. The study explored why ACP, which allows people to record their wishes and preferences for future care, is not consistently used despite evidence that it improves patient experience, supports informed decision-making and can help people receive care in their preferred place. 

The research found broad agreement among professionals that conversations about future care often happen too late, usually after a person has become seriously ill. ACP was seen as most effective when discussed earlier in life, rather than only at the end-of-life stage. However, a range of barriers were identified, including poor integration of information systems, inconsistent documentation, lack of staff confidence and training, limited time to have meaningful conversations, and insufficient follow-up or review of care plans. 

Public awareness was also identified as a significant challenge. Many people were uncomfortable discussing death and future care preferences, while others viewed ACP as something only relevant to people who were dying. The report highlighted a need for wider cultural change to encourage earlier conversations about future healthcare decisions and personal wishes. 

Overall, the report concluded that Advance Care Planning has the potential to improve end-of-life care significantly, but that system-wide changes are needed to support its wider adoption. Recommendations included developing shared information systems, creating a consistent local ACP framework, providing additional staff training and support, making ACP documents more accessible, and raising public awareness so that planning for future care becomes a normal part of life rather than a discussion reserved for the end of life.