Background Paediatric advance care planning typically involves parents for surrogate decision-making as many children do not have the capacity to consent due to developmental immaturity or communication impairment in view of clinical condition. It requires effective communication to clarify goals of care while focusing on the future wishes, and establish agreement on preferred treatments with the development of an advance care plan document.

Methods Paediatric Palliative Care Service (PPCS) has health care professionals (HCP) who provide palliative care for children aged 0–18 years. All members are qualified facilitators and the number of completed advance care planning (ACP) document for all new referrals to the service is measured annually. Conversation with them where appropriate is set as a measure to effectiveness of the care rendered. The present study will be the analysis of discussions with parents of children (non- oncology group and oncology) referred to palliative team from 2020–2022.

Results The previous analysis in 2018, 5 (21%) new patients referred to PPCS completed advance care planning documents of which 8% (2) of patients were from oncology and 13% of patients were from non-oncology group. Two children (40%) had their wishes respected. Most parents were reluctant to engage the discussion initially however stated a relief once the document was completed. Majority of them would like medical team updates and assistance in their decision making. Some did not feel comfortable, not ready and refused participation while some did not complete the session. Few were not averse to escalation of care as afraid physicians are giving up. The detailed analysis for 2020–2022 on parents’ preferences and challenges will be presented.

Conclusion Though ACP provides an action plan for everyone, future care plan around end-of-life (EOL) for children is most challenged by high emotional impact related to end-of-life care decisions.