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Lancet Oncol. 2017 Sep;18(9):e543-e551. doi: 10.1016/S1470-2045(17)30582-X.

Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care.

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Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands. Electronic address:
Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
Department of Medical Humanities, Julius Center, University Medical Center, Utrecht, Netherlands.
School of Medicine, University of North Carolina, Chapel Hill, NC, USA; School of Medicine, Yale University, New Haven, CT, USA.
Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands.
Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.
Department of Research and Education, CIRO Centre of Expertise for Chronic Organ Failure, Horn, Netherlands; Centre of Expertise for Palliative Care, Maastricht University Medical Centre, Maastricht, Netherlands.
Palliative Care Unit, Carlo Poma Hospital, Mantova, Italy.
International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
School of Nursing and Midwifery, University of Sheffield, Sheffield, UK.
Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Geriatric Palliative Care, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.


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.

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