The key finding
A 2025 scoping review reveals that future care planning (FCP) is emerging as a broader policy approach to end-of-life care that goes beyond traditional advance care planning. Unlike conventional advance directives, which only apply when someone can make their own decisions, FCP explicitly includes frameworks for people with diminished decision-making capacity through a best-interests approach. This policy framework has been adopted into national health strategies in Wales and Scotland, though researchers identified a need for clearer, more consistent definitions to help healthcare professionals implement it effectively.
What the study looked like
This was a scoping review, a type of research that maps existing literature on a topic rather than testing a specific hypothesis. The researchers surveyed published papers, policy documents, and healthcare guidelines discussing future care planning within supportive and palliative care contexts, focusing primarily on the UK but including international sources. They examined how FCP is defined across different settings, how it differs from advance care planning, and how it’s being implemented in various healthcare systems. The review specifically looked at policy adoption in countries like Wales and Scotland, and analyzed how palliative care settings worldwide are incorporating FCP into practice. The researchers aimed to synthesize what constitutes a future care plan and what elements it should include.
Why researchers think this happened
The authors propose that FCP emerged in response to limitations in traditional advance care planning, which typically requires individuals to articulate their wishes while they still have full decision-making capacity. As populations age and conditions like dementia become more prevalent, healthcare systems face increasing numbers of patients who never completed advance directives or who lose capacity before expressing preferences. The best-interests framework within FCP addresses this gap by providing a structured approach for healthcare teams and families to make decisions on behalf of those who cannot speak for themselves. The researchers suggest that national policy adoption in Wales and Scotland reflects growing recognition that comprehensive end-of-life care requires planning mechanisms that work across the entire trajectory of declining capacity, not just at its beginning.
How to read this carefully
As a scoping review rather than an empirical study, this research maps the landscape of existing literature but doesn’t test FCP’s effectiveness through controlled trials. The authors themselves note that definitions of FCP vary across the literature, which could lead to inconsistent implementation. The review focuses heavily on UK policy contexts, so findings may not translate directly to healthcare systems with different structures or cultural approaches to end-of-life care. Importantly, while FCP is being adopted in national strategies, the review doesn’t provide data on patient outcomes, family satisfaction, or whether FCP actually improves end-of-life experiences compared to traditional approaches. The fact that researchers called for clearer definitions suggests the field is still developing its frameworks and evidence base.
What this means for everyday life
If you or a family member faces serious illness, this research highlights that conversations about future care can remain meaningful even if someone’s ability to make decisions declines. Given that FCP frameworks are being formalized in some regions, it might be worth asking healthcare providers whether your area has adopted similar approaches and what tools are available. For those caring for aging relatives or people with progressive conditions like dementia, understanding that formal planning mechanisms exist for situations where traditional advance directives fall short could inform conversations with medical teams. The research also suggests that as these frameworks develop, advocating for clear communication about what FCP means in your specific healthcare context could help ensure the approach works as intended for you and your loved ones.