One in 3 Australians live in regional, rural or remote areas. Those that do, face significant inequities in healthcare, experience more chronic disease and die younger than those in major cities. Advance Care Planning (ACP) is an important public health initiative that can improve the quality, continuity and efficiency of end-of-life care, with particular relevance in regional, rural and remote areas.  

ACP involves patients discussing their healthcare preferences with their family, carers and providers, with the purpose of guiding future treatment, should the patient lack capacity. ACP is regarded as a positive contributor to end of life care internationally, and can increase compliance with patients’ treatment preferences, reduce hospitalizations, deaths in hospital and the psychological distress experienced by bereaved family members. Important for policy makers, ACP can also reduce the costs of end of life care particularly in relation to hospital admissions, with cost savings exceeding $13,000 per decedent in the last 6 months of life. 

Despite the benefits of ACP, uptake in Australia has been limited. Several attitudinal and structural barriers to ACP have been identified, for example, some patients have limited knowledge about ACP and its benefits; some providers lack time and confidence to discuss end of life plans; while others are hesitant to talk about ACP as they do not wish to distress their patient or deprive them of hope. Yet once ACP occurs, most patients and their caregivers report little to no distress and find the process to be somewhat to very helpful. 

Conversely if discussions are not initiated until a patient’s condition has deteriorated and they are nearing death, ACP has the potential to exacerbate stress for patients and their families. This scenario may also decrease concordance with patient end of life requests, as well as increasing futile care and re-admissions.