The role of mediation in advance care planning and end-of-life care

Background General practitioners (GPs) play a key role in advance care planning (ACP), but face a number of difficulties in implementing ACP in routine practice, including fear of disputes involving the patient's family members. The interest-based negotiation approach employed by professional mediators may be a useful way of eliciting patients' and their family members' interests in ACP discussions, and establishing agreement and commitment to an advance care plan. Objectives This article introduces the key skill set of professional mediators, examines how this approach can be employed in general practice and presents an 'interest mapping tool' to assist the GP in managing ACP discussions. Discussion Interest-based negotiation differentiates between a person's stated position and the interests underlying that position. By eliciting interests, the GP gains deeper insight into the factors driving patients' and their family members' preferences, and can identify shared interests as a basis for establishing agreement.