Given our ageing population and the increased prevalence of chronic illness, knowledge of advance care planning among health and aged care professionals is increasingly important.

This framework provides a structure to support the development of health professionals' knowledge and skills in this area.

Framework overview

The framework is primarily intended for implementation by health practitioner educators at varying levels of experience including vocational education and training courses, undergraduate and postgraduate courses, and specialty training colleges.

The framework is designed to assist education providers to incorporate advance care planning into their curriculum. It aims to provide a range of education resources including online modules, lecture topics and interdisciplinary case studies that allow for simulation and role-play.

The framework outlines expected skills that a health professional would demonstrate across five key content areas:

  • Communication with the person/family/carers
  • Communication with the team
  • Communication over time
  • Ethics
  • Law

Implementing the framework

We have produced a guide which aims to support the implementation of the framework into courses and specialty training. The guide and supporting educational resources are designed to enable teaching staff to self-select relevant advance care planning content.

Download the implementation guide [PDF 1357.03 KB] to find out how to integrate advance care planning into your curriculum.

Download the Framework [PDF 124.28 KB]

Case study

We've developed ten realistic and specific case studies to be used by teaching professionals. They can be modified as required.

The case studies have been created to directly reflect the level one capabilities outlined in the framework, so they can be used with students with a limited understanding of advance care planning.

If you would like to request Word versions of the Education Capability Framework, Implementation Guide or Case Studies, please email your request to

Paediatric case study

Jenny is a 15 year old girl with osteosarcoma requiring radical treatment. Her parents have differing perspectives on the best approach to treatment. Discuss the role of advance care planning in the context of the paediatric setting and consider the ethical deliberations in advocating for a child and negotiating between parents.

View case study [PDF 144.83 KB]

Acute emergency case study

Dianne’s chronic kidney disease has progressed. She is admitted to an acute hospital with delirium. Is this a trigger for advance care planning? Work through the considerations to ensure Dianne is receiving the highest quality patient-centred care.

View case study [PDF 149.24 KB]

Aged care case study

Yuri is a 78 year old widow with multiple pre-existing health issues. He has a recently diagnosed chest infection and limited mobility due to a fall. There are multiple reasons to initiate advance care planning and facilitate Yuri identifying a substitute decision-maker.

View case study [PDF 152.81 KB]

Palliative care case study

As her metastatic breast cancer progresses, Michelle and her husband Peter need to reconsider the plan of care. Michelle’s deteriorating condition means preferences for treatment on her advance care planning may require modification to reflect her current wishes.

View case study [PDF 150.96 KB]

ICU case study

Carmel is a 52-year-old female who is in ICU, unable to communicate, following a ruptured brain aneurysm. Navigate the complexities surrounding establishing Carmel’s preferences for treatment and identifying her substitute decision-maker.

View case study [PDF 151.36 KB]

Disability case study

Jose is 26 years old and has muscular dystrophy with associated complex needs. He has been admitted to hospital with pancreatitis and wishes to discuss his care preferences. Jose is concerned there may be potential family conflict and acceptance of his treatment choices may be challenged. Discuss how advance care planning may benefit Jose and his family.

View case study [PDF 144.06 KB]

Rural case study

Margaret is 48 years old and is living with relapsing remitting multiple sclerosis (MS). Margaret lives in Albany, WA, and has recently returned home following a hospital admission to Perth (400km away) following a recent exacerbation. Consider the role of advance care planning in this situation.

View case study [PDF 152.9 KB]

Dementia case study

Joan is 81 years old and has advanced dementia with no decision-making capacity. She has recently moved into residential aged care. Joan has aspiration pneumonia and a decision whether to go to hospital needs to be made. Discuss the considerations required to make the required decision.

View case study [PDF 145.53 KB]

Primary care / community case study

Michael is a 70 year old man with chronic obstructive pulmonary disease (COPD) who lives with his wife Cherry and they have 3 adult children. Michael and Cherry have an appointment with their GP. The advance care planning conversation is initiated.

View case study [PDF 147.95 KB]

Community / allied health case study

Noelene is a 58 year old single woman who has chronic pain, fibromyalgia, chronic fatigue and is on a disability pension. Noelene lives at home, alone, and attended the pain management clinic for assistance with exacerbation of pain. Consider advance care planning in the context of chronic disease and the benefits it offers.

View case study [PDF 147.71 KB]

Last updated: September 2023