预先护理计划（ACP）是一个讨论、反思和沟通的过程，能够规划未来的医疗。尽管有证据表明 ACP 对患者、家庭和医疗保健系统有好处，但许多人在没有机会进行此类对话的情况下就去世了，特别是那些患有进行性非恶性疾病的人。 2020 年推出的皇家全科医生学院和居里夫人水仙花标准为初级护理提供了改善临终护理的结构，包括提供 ACP。主动识别患者是该方法不可或缺的一部分。我们报告了一个质量改进项目，旨在使用“对您来说重要的事情”(WMTY) 框架来评估及时和个性化的 ACP 对话在一般实践中的接受率和可接受性，并确保包括不同的诊断和人口统计群体。以前没有 ACP 且可能在生命最后一年的患者会接受 ACP 对话；一项调查寻求反馈。81% 接受了该提议，并且在大多数情况下，使用格洛斯特郡认可的记录 ACP 对话的格式（紧急护理和治疗推荐摘要 (ReSPECT) 计划）记录未来护理指南。临床医生和患者满意度很高。我们得出的结论是，使用“WMTY”格式的 ACP 讨论对于大多数人来说是高度可接受的。有了公认的推动因素并最小化已知的障碍，有价值的个性化对话就发生了。重新构建对话以关注某人想要如何生活，同时包括他们对死亡的优先考虑，可能会改变临床医生和公众对此类对话的看法。它可以消除负面关联（例如将这些对话与即将发生的死亡联系起来），这可能会增加所有人发起讨论的动力。ACP 对话已被证明是最佳实践，并且可以通过调整实践流程和临床医生教育而成为全科实践中的例行公事； Daffodil 标准促进持续的质量改进。© 作者（或其雇主）2024。根据 CC BY-NC 允许重复使用。不得商业再利用。请参阅权利和权限。英国医学杂志出版。

Advance care planning (ACP) is a process of discussion, reflection and communication, enabling planning for future medical treatment. Despite evidence of benefits of ACP to patients, families and the healthcare system, many die without an opportunity for such conversations, particularly those living with progressive non-malignant conditions. The Royal College of General Practitioners and Marie Curie Daffodil Standards launched in 2020 provide primary care with a structure for improving end-of-life care, including delivery of ACP. Proactive identification of patients is integral to the approach.We report on a quality improvement project which aimed to assess the take-up rate and acceptability in general practice of a timely and personalised ACP conversation using a 'What matters to you' (WMTY) framework, and to ensure that different diagnostic and demographic groups were included.Patients without previous ACP and potentially in the last year of life were offered an ACP conversation; a survey sought feedback.81% accepted the offer and in most cases, future care guidance was documented using the recognised format in Gloucestershire for recording ACP conversations, the Recommended Summary for Emergency Care and Treatment (ReSPECT) plan. Clinician and patient satisfaction was high.We concluded that an ACP discussion using a 'WMTY' format was highly acceptable to most. With recognised enablers in place and known barriers minimised, valuable personalised conversations occurred. Reframing the conversation to focus on how someone wants to live, while including their priorities for death, could alter how such conversations are perceived by clinicians and the public. It could remove negative associations (such as linking these conversations with an imminent death), which may increase motivation for all to initiate discussions.ACP conversations are evidenced best practice and could become routine in general practice with adjustments to practice processes and clinician education; the Daffodil Standards facilitate continued quality improvement.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.