Background Eliciting and honouring treatment preferences is a fundamental goal of advance care planning. However, is it unclear how well advance care plans reflect the current preferences of patients or how well patients understand the implications of their decisions.

Aim To describe factors that influence how well advance care plans reflect informed patient preferences.

Methods A review of the empirical and theoretical literature on advance care planning.

Results Several factors were identified that influence how well advance care plans reflect patient preferences. Important characteristics of the decision-maker include health literacy, knowledge about treatment decisions, the preferred level of involvement in decisions, cognitive functioning, and health status. Important factors related to the facilitator include professional background, training in advance care planning facilitation skills, and documentation strategies. Key characteristics of the conversation include the length of time since the advance care plan was created, the setting, and how involved the patient was in the discussion. Methods challenges were identified as well contextual influences.

Discussion Findings suggest that multiple factors influence how well advance care plans reflect patient preferences. This complexity requires a multi-faceted strategy to ensure advance care plans match patient preferences.

Conclusion Future research is needed to evaluate the complex patient, facilitator, and conversations characteristics that influence how well advance care plans reflect patient preferences with the goal of developing innovative, evidence-based strategies to improve the quality of advance care plans.