Background Although the importance of ACP is not contested, little is known about the preferred timing and preferred initiator of ACP discussion.

Aim Get insight in preferred timing and preferred initiator of ACP discussion from different perspectives.

Methods Online questionnaire (june–oct 2013) among Dutch patients, relatives, physicians and nurses with experience with end-of-life care. Participants were recruited through patient, elderly and medical organisations and snowball sampling. In total 88 patients, 570 proxies, 349 physicians and 389 nurses filled in the questionnaire.

Results Respondents differed in their ideas when ACP should be initiated: While the answer most often given by relatives was  that ACP should best be initiated before illness (45%), patients (42%) and physicians (50%) mostly thought that the best timing is after diagnosis of a serious illness/frailty, and most nurses (46%) thought in case of incurability or imminent death. Most respondents described that a conversation about ACP could be initiated by patient, physician, relative as well as nurse. According to patients and relatives, the preferred person (s) to start this conversation were the patient (90%) and, less frequently, the physician (52%). Physicians and nurses more often described the physician (80–81%) than the patient (61–69%) as preferred initiator. More than the other respondents (15–19%), nurses described a nurse as preferred initiator (37%).

Conclusion There is no consensus about preferred timing among patients, relatives, physicians and nurses. All participants describe their own responsibility in initiating ACP, but initiating a conversation on ACP is a task for all involved.