It can be difficult to identify which children would benefit from an advance care planning discussion, and there is no universally accepted set of triggers (Lotz et al. 2015; Hain et al. 2013; Brook and Hain 2008). This will be an important area for future research (Hain et al. 2013).

One of the simplest indicators is known as the ‘surprise question’, in which the treating doctor asks him or herself, ‘Would I be surprised if this child died within a year?’

If the answer is ‘no [I would not be surprised]’, the advance care planning process should begin (Murray and Boyd 2011; Feyi et al. 2015).

A list of specific conditions in which initiating and progressing advance care planning is recommended can be found in the Thinking ahead framework. 

Appendix 2 - Suggested triggers to commence Step 1 of ACP discussion

Appendix 3 - Suggested triggers to progress to steps 2 and 3