Advance care planning unfolds over time.

Even in the most acute situations, the conversation should not begin with a discussion about specific interventions.

Step 1: Living with a life-limiting illness

These discussions should occur soon after diagnosis of a life-limiting condition, or during a stable phase (see Appendix 2 for a list of life-limiting conditions where at least step 1 of advance care planning is recommended).

Step 2: Current or potential future deterioration

This builds on step 1. It should occur where there is deterioration or risk of sudden, acute deterioration (see Appendix 3 for recommended triggers).

Step 3: The goals of care document

This builds on steps 1 and 2. It should be completed if there is a significant risk of sudden, acute deterioration (see Appendix 3 for recommended triggers).

Step 4: End-of-life care

This should occur if the child is clearly dying and the primary goal of care is comfort.