Within the Australian healthcare policy framework, advance care planning (ACP) is intended to ensure quality care according to individual wishes at end of life. An advance care plan, sometimes called a ‘living will’ or an advance care directive provides directions describing how an individual would prefer to be treated in the event of a loss of capacity to direct one’s own care. ACP emerged as a rights-based initiative in the USA in response to societal demand for the right to self-determination about medical care at end of life. This concern resonates internationally including in Australia where policies and/or laws have been enacted across all states and territories to support the uptake of ACP.

Australia’s population profile is increasingly aged with an increasing life expectancy. For most Australians death will occur ‘at an advanced age following a period of chronic illness and decline’. Associated with increasing age, loss of cognition may limit an individual’s ability to make autonomous decisions at end of life. Advances in medical technology have resulted in the ability of practitioners to intervene and maintain life past what was previously possible, though quality of life resulting from the interventions is not assured. In these contexts, ACP is viewed as an important and emerging issue in the public health domain.

How advance care planning (ACP) is conceptualised in Australia including when, where and how ACP is best initiated, is unclear. It has been suggested that healthcare delivered in general practice provides an optimal setting for initiation of ACP discussions but uptake remains low. This systematic review and critical interpretive synthesis sought to answer two questions:

(1) What are the barriers and enablers to uptake of ACP in general practice?

(2) What initiatives have been used to increase uptake of ACP in general practice?