Person at a crossroads symbolizing end-of-life decisions

Advance Care Planning: Does Talking About End-of-Life Wishes Really Make a Difference?

Elliot Brynn in Health & Wellness December 2025 • 5 min read.

"A new study examines the impact of advance care planning on end-of-life care, challenging assumptions about its effectiveness in improving patient outcomes and family well-being."

In an era where patient-centered care is increasingly emphasized, advance care planning (ACP) has emerged as a cornerstone of modern healthcare. The core idea behind ACP is simple yet profound: empowering individuals to define their values, express their preferences, and make informed decisions about their future medical care, especially as they approach the end of life.

For individuals facing incurable illnesses, ACP offers a framework for discussing difficult topics, ensuring their voices are heard, and alleviating potential burdens on their families. It's often seen as a way to ensure that medical interventions align with personal wishes, promoting a sense of control and dignity during challenging times. But how well does this concept hold up in practice? A recent study published in the British Journal of Cancer challenges some of the conventional wisdom surrounding ACP.

The study, a randomized controlled trial conducted across multiple Australian oncology centers, investigated whether a formal ACP intervention truly improved end-of-life care for patients with incurable cancer. The results, as we will see, raise important questions about the real-world impact of ACP and highlight the complexities of end-of-life decision-making.

The Advance Care Planning (ACP) Study: Unveiling the Nuances of End-of-Life Care

Person at a crossroads symbolizing end-of-life decisions

Researchers modified and assessed the effectiveness of an advance care planning (ACP) intervention, which previously demonstrated improved compliance with patient's end-of-life (EoL) wishes in a different patient demographic. Between April 2014 and January 2017, individuals with incurable cancer and their Family Members (FM) were randomly assigned to either standard care or standard care supplemented with an ACP intervention. It was not possible to blind the oncologists and participants. The ACP model was based on 'Respecting Patient Choices', which offers personalized scenarios for typical, best-case, and worst-case survival outcomes.

Seven facilitators (comprising two oncology nurses, two nurses, and three allied health professionals) delivered the intervention within two weeks of enrollment. The primary outcome was assessed via FM interviews conducted three months after the patient's death. Researchers measured the FM's perception of whether the patient's wishes had been discussed and fulfilled.

Study Size and Demographics: 665 patients were considered; 444 met criteria, but only 208 patients (47%) and their family entered the trial.
Intervention Details: 53 (46%) dyads in the ACP group and 63 (54%) dyads in usual care had complete primary outcome data. The mean discussion length was 57 minutes.
Key Finding: FM perception that patient EoL wishes were discussed and met was 43% in the ACP group vs 33% in usual care (p = 0.27).

The study concluded that a formal ACP intervention didn't significantly increase the likelihood that end-of-life care aligned with patient preferences. Palliative care referral rates were high in both groups (97% vs. 96%). There were no significant group differences in EoL care, patient satisfaction, FM satisfaction, or FM well-being. The researchers hypothesized that ACP would increase discussion and documentation of patient wishes, improve the quality of death, and reduce distress in family members. The study challenges some common assumptions about the benefits of ACP.

Rethinking Advance Care Planning: A Call for Nuance and Integration

This study underscores the complexities of end-of-life care and suggests that simply implementing formal ACP interventions may not be a guaranteed path to improved outcomes. While ACP can be a valuable tool for facilitating conversations and documenting preferences, it's crucial to recognize its limitations and consider the broader context of care. Future research should focus on refining ACP models, integrating them seamlessly into existing care pathways, and addressing the individual needs and preferences of patients and families. Ultimately, the goal is to ensure that end-of-life care is not only consistent with patient wishes but also compassionate, supportive, and truly patient-centered.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1038/s41416-018-0303-7, Alternate LINK

Title: A Randomised Controlled Trial Of An Advance Care Planning Intervention For Patients With Incurable Cancer

Subject: Cancer Research

Journal: British Journal of Cancer

Publisher: Springer Science and Business Media LLC

Authors: Stephanie B. Johnson, Phyllis N. Butow, Melanie L. Bell, Karen Detering, Josephine M. Clayton, William Silvester, Belinda E. Kiely, Stephen Clarke, Lisa Vaccaro, Martin R. Stockler, Phillip Beale, Natalie Fitzgerald, Martin H. N. Tattersall

Published: 2018-10-29

Everything You Need To Know

What is Advance Care Planning (ACP) and why is it important?

Advance Care Planning (ACP) is a process that empowers individuals to define their values, express their preferences, and make informed decisions about their future medical care, especially as they approach the end of life. It's crucial for individuals facing incurable illnesses because it provides a framework for discussing difficult topics, ensuring their voices are heard, and alleviating potential burdens on their families. ACP aims to align medical interventions with personal wishes, promoting a sense of control and dignity during challenging times.

What were the main findings of the study on Advance Care Planning (ACP) for incurable cancer patients?

The study, a randomized controlled trial, investigated whether a formal ACP intervention truly improved end-of-life care for patients with incurable cancer. The main finding was that the formal ACP intervention didn't significantly increase the likelihood that end-of-life care aligned with patient preferences. The researchers measured the Family Member's (FM) perception of whether the patient's wishes had been discussed and fulfilled, finding only a small difference between the ACP group and the usual care group (43% vs 33%, respectively). The study also found no significant group differences in end-of-life care, patient satisfaction, FM satisfaction, or FM well-being.

How was the Advance Care Planning (ACP) intervention implemented in the study?

The ACP intervention was based on 'Respecting Patient Choices', which offered personalized scenarios for typical, best-case, and worst-case survival outcomes. Seven facilitators, including oncology nurses and allied health professionals, delivered the intervention within two weeks of enrollment. The intervention involved discussions about end-of-life (EoL) wishes. The mean discussion length was 57 minutes. The primary outcome was assessed via Family Member (FM) interviews conducted three months after the patient's death.

What are the implications of the study's findings on Advance Care Planning (ACP) for patients and their families?

The study's findings suggest that simply implementing formal ACP interventions may not guarantee improved outcomes. While Advance Care Planning (ACP) can be a valuable tool for facilitating conversations and documenting preferences, it's crucial to recognize its limitations. The study underscores the complexities of end-of-life care and highlights the need for nuance and integration. For patients and their families, this means that while discussing end-of-life wishes is important, it may not, on its own, ensure that those wishes are met. It calls for a broader approach that considers the individual needs and preferences of both patients and families, integrating ACP seamlessly into existing care pathways.

What are the recommendations for future research and practice regarding Advance Care Planning (ACP)?

Future research should focus on refining Advance Care Planning (ACP) models and integrating them seamlessly into existing care pathways. This includes addressing the individual needs and preferences of both patients and families. The goal is to ensure that end-of-life care is not only consistent with patient wishes but also compassionate, supportive, and truly patient-centered. The study suggests that a more holistic approach, considering the broader context of care, is needed to improve outcomes. This involves considering other factors such as the quality of communication, the emotional support provided to patients and Family Members (FM), and the availability of palliative care services.