‘... the doctor has the map and the patient does not. In fact the doctor not only has the map but drives the vehicle and the patient may not know that they have reached a crucial crossroads, or that they have reached the end, until they get there and it is too late.’1
INTRODUCTION
Care of the dying is inadequate in many developed countries, and its improvement is an important national and international challenge. Around 500 000 people die in England every year, of whom 53% die in hospital even though 63% indicate a preference to die at home.2
Although palliative care services have been available for many years for people with cancer, most people do not die of cancer. Other conditions, including multimorbidity and extreme old age, tend to have a less predictable course and such patients are less likely to be found on a GP’s palliative care register.
Do older patients really have a voice when it comes to planning their future care? In the first ever systematic review of attitudes of the public and healthcare professionals to advance care planning, Sharp et al find there are some critical barriers to be overcome if we are to translate the concept of ‘advance care planning’ from its origins in palliative care for cancer to frail older people who are dying.3
We know what we ‘should be doing’. Why aren’t we doing it? In this editorial we examine the opportunities and challenges of advance care planning in the context of a much needed national conversation about death and dying.4
WHAT SHOULD WE BE DOING?
Advance care planning is defined as the ‘voluntary process of discussion and review to help an individual who has the capacity to anticipate how their condition may affect them in the future and if they …