Advance care planning unfolds over time. Even in the most acute situations, the conversation should not begin with a discussion about specific interventions. It should begin by talking about what the family understands about the situation, what is important to them, what their hopes and goals are, and what their fears are. TheThinking ahead framework provides a four step approach to conversations.

Each party brings their own expertise. The child and parent bring particular knowledge of their values and priorities, and the treating team brings knowledge about the diagnosis, prognosis and possible treatments. The treating team should then provide guidance based on the clinical situation and the child’s and family’s values and goals.

The goals of care document is one component of the advance care planning discussion. It is not a statutory legal document and it does not need to be signed by parents. It is a communication tool that captures any decisions that have been made regarding medical treatments that should or should not be provided.

It is the discussion with family members, clinicians and significant others that is the important element. People may choose not to compete a document, however, putting decisions in writing strengthens the process.

It is important not to treat advance care planning as a form-filling exercise with parents. Rather, explain that decisions will be documented based on the discussion so that other staff can find critical information quickly in the event of an acute deterioration.

Some parents may wish to see and keep a copy of the goals of care document, others will not.

Medical, nursing and allied health staff can discuss and document Steps 1, 2 and 4. Step 3 should only be completed by senior medical staff.

The suggested prompts are just a guide. You don’t have to ask all the questions. They are designed to include parents and children where appropriate. Even young children can provide insights into their goals for their care, their hopes and fears as well as things they find hard and things they enjoy. These insights can help the adults in their lives make the best possible decisions.

It may not always be possible to complete a goals of care document before an acute deterioration occurs. Information gathered from discussions based on the Thinking ahead framework Steps 1 and 2 will still be helpful to staff dealing with such an event.