Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel

Area of Science:

• Gerontology
• Medical Ethics
• Health Policy

Background:

• Despite growing interest, a clear consensus definition for advance care planning (ACP) is lacking.
• Existing descriptions of ACP do not provide a unified framework for clinical, research, or policy efforts.

Purpose of the Study:

• To establish a consensus definition for advance care planning (ACP) applicable to adults.
• To create a unified understanding of ACP to guide future initiatives.

Main Methods:

• A multidisciplinary Delphi panel of 52 international experts (clinicians, researchers, policy leaders) and a patient/surrogate advisory committee was convened.
• Ten rounds of a modified Delphi method were employed, involving qualitative analysis of expert input to iteratively develop the definition.

Main Results:

• Panelists addressed key tensions in ACP, including focus on conversations versus directives, values versus preferences, and decision-making scope.
• A consensus definition was achieved: 'Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.'
• An accompanying goals statement emphasized aligning medical care with patient values during serious illness, alongside strategies to support ACP.

Conclusions:

• A consensus definition for adult advance care planning (ACP) was successfully developed by a diverse expert panel.
• This definition provides a foundation for implementing and measuring ACP in clinical settings, research, and policy development.