For sensitive religious and cultural advance care planning

ACP Discussion Scripts

It can be difficult for some health professionals to know what to say in advance care planning. How do you start the conversation? How do you find out what you need to know?

We have included a number of script examples, provided by general practitioners, nurses and religious and cultural leaders to assist you in initiating and continuing ACP conversations.

Starting the conversation early – when healthy

“You are perfectly healthy... but I've started to bring up the idea of advance care planning with patients. Unfortunately I've seen many patients and their families who have suddenly been faced with end of life decisions... Even though it can feel awkward to think about this now, it's almost always better to think through it now, make some notes, and then put them away where someone knows about them, than for you and your family to think about it in a very tense and emotional situation that's much more urgent.”

“This isn't something you might want to think about right now but just letting you know it's something we can help you with, if you decide you want to have the conversation you can let me know and we can start talking about it.”

“A lot of people plan things ahead since they don't want to be a burden to anyone else, they don't want to hassle their children or grandchildren – part of this might be burial plots, or in this case, treatment preferences.”

“Planning ahead is always a good idea, and can give you calmness for whatever happens in the future. You might have an insurance, life insurance for example, but it is also important to plan for your future care should you not be able to make those decisions anymore yourself for some reason. So your preferences and wishes will be known, and your loved ones won't have to guess or feel guilty about what to do, what might be best for you, or what they think you might want.”

“If there is a situation when I'm looking after you, what do you need for support, and what would your wishes for care be if you were unable to make decisions?”

Inviting Family or other Support People

“If you ever have any serious medical issue, would you like me to tell you about it straight away, or talk to you about it with a family member?”

“...It might be good if you've got someone beside with you who can remind you of what was said.”

“We're going to have a family meeting and [this] is what we're going to talk about... Who would you like to be there? What do we need to do and have in place?”

If the person has a poor prognosis...

“Well, we've got some bad news. Shall I give you some of that now and we'll get you back in a few days' time to have another talk then?”

“...You understand your lungs aren't functioning that well... if things seriously deteriorate, what would you like our treatment goals to be?”

“He is really unwell, are there any festivals or celebrations that are important for him in the next few months that we can help celebrate?”

“How could I say things that would make it more understandable or not so distressing for you?”

Checking their understanding

“What do you understand is going to happen with the next lot of treatment? What are your feelings on how effective it may be and if it's not effective?”

“What do you understand is wrong with you? What have you been told? Where do you think you're at, at the moment?”

“We discussed this last time... how do you feel about it, or have you given it any further thoughts?”

Understanding the meaning of their faith

“I understand from what you've told us before that you follow the (insert faith) faith, what does that mean for you? What is it that you think I need to understand to be able to support you?”

“What's important to you and what can I do as a health professional to support you? How do I need to act in particular situations? Is there anything I need to avoid saying?”

“What are your beliefs and thoughts about the future? What are your thoughts about the process of passing on? Are you fearful or worried about it?”

“What aspects of (insert faith) do you follow? Do you follow it implicitly or are there variations?”

“I know you're (insert faith), I don't know much about your culture. What are some of the important cultural aspects that define your life and give you meaning in life? How do they relate to your medical care?”

“Are there any specific religious requirements you need (e.g. a prayer room)?”

“Do you have a religious leader you're close to? Do you belong to a religious community? Would you like to involve your religious leader?”

“What does dying mean for you? How do you feel about that?”

“What are the things that are important for you, especially in the kind of care that you want to receive?”

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