Background Advance care planning (ACP) is a process of formal decision making and documentation for future reference. There’s a risk that what is expressed during ACP may not be plausible within the available healthcare provision or be inappropriate. Deterioration of the patient’s condition could mean that what was once possible is no longer. If this is not effectively communicated then there is potential for unnecessary distress, anguish and conflict. For this to be communicated effectively nuances such as the difference between; ‘Choice’, ‘Preference’ and ‘Rights’ are paramount. This understanding needs to be on both sides of the consultation table for effective communication.

Aim To explore the perceptions and understanding of the terms; ‘Choice’, Preference’ and ‘Rights’ of the multidisciplinary hospice team in relation to aspects of ACP.

Methodology An electronic survey completed by clinical staff within Severn Hospice over a week period.

Results There were 32 respondents from eight different job roles. 69% (n=22) stated ‘where you die’ as a ‘Preference’ with 28% (n=9) stating it a ‘Choice’. Explaining DNACPR demonstrated; ‘Choice’ 39% (n=12)/‘Preference’ 29% (n=8)/‘Right’ 35% (n=11). Decisions regarding refusing care were mostly seen as a ‘Right’ (62% n=20) whereas requesting aspects of care such as admission and medications were perceived as ‘Choice’ (40% n=13) or ‘Preference’ (37% n=12). The qualitative aspect asked for perceived definitions of ‘Choice’, ‘Preference’ and ‘Rights’ which we split into multiple themes. ‘Choice’ had predominance of the themes of ‘options’ and ‘information’. ‘Preference’ had predominant themes of ‘options’ and ‘if possible’. Rights had a more ‘legal’ aspect.

Conclusion There is considerable heterogeneity in the understanding of the terms; ‘Choice’, Preference’, and ‘Rights’, and even more so between the terms ‘Choice’ and ‘Preference’. Given this is conducted upon hospice staff this gives measure for concern as potentially conflicting messages and understanding could be communicated.