ABSTRACT
Documented advance care planning (ACP) discussions with patients enable doctors to have continuity and collaboration across all settings as patients move from one setting to another. These shared decision-making discussions generally consist of 3 steps: giving information; assisting patients to understand the options in the context of their situations; and helping these patients make informed decisions based on their individual preferences. Primary care physicians should take advantage of their position as healthcare providers to continue the care of the patient and the relationship they have with the patient by initiating ACP discussions. The National Medical Ethics Committees recommendation in 2010 is that such discussions should be started as part of routine care in primary care and outpatient settings before individuals become acutely unwell. Important barriers that need to be overcome are negative encounters with different personalities who can present themselves as difficult - the angry patient, the anxious patient, the patient in collusion, and the patient in denial. In this paper are some guiding principles on how to carry out ACP discussions with such patients. There is also a need for doctors to recognise that as caregivers, they may be exhibiting blocking behaviours to ACP discussions that patients are trying to initiate. These should be avoided.