Introduction Advance care planning is a means for patients to communicate their wishes, fears and desires for future health decisions should they lose the ability to consider or communicate these. Despite being supported by governments and healthcare leaders, uptake amongst the general population remains low. Nurses play a crucial role in promoting and engaging with these discussions given their close relationship with patients and families in a range of clinical settings. Aim To describe the barriers that nurses and healthcare professionals believe prevent them from exploring advance care planning with their patients. Method We carried out a systematic review of peer‐reviewed journal articles from the databases MEDLINE, Embase, CINAHL Plus, Web of Science and ProQuest Central, guided by the PRISMA checklist. Results Eleven articles were identified: all were self‐reporting surveys using a mix of open and closed questions. They originated in the USA, Canada, Australia and Ireland. The participants included various healthcare professionals, with the majority of studies focussing on nurses. The two most important barriers to advance care planning are lack of education and insufficient time. Advance care planning appears to be well supported, and nurses and healthcare professionals report themselves to be comfortable and confident to take on the responsibility. Conclusion There is a need for greater education and training for nurses and healthcare professionals. In particular, there needs to be better understanding of professional and legal responsibilities. The need for sufficient time to be made available to allow these conversations, in often busy settings, will need institutional and financial support. Relevance to clinical practice Increased training and knowledge are likely to lead to more positive attitudes and greater confidence for nurses, and other healthcare professionals, which should help support and encourage patient engagement with advance care planning.

Whilst the risk of dying after an operation in the UK is very small, the volume of surgery means that there are 20 000e25 000 deaths each year. For these patients and others who suffer major complications, critical illness often leads to a loss of capacity. If wishes are not discussed in advance, the patients may be excluded from meaningful involvement in decisions affecting their care. The preoperative period has been postulated as one where advance care planning could begin by engaging in voluntary conversations about an individual's wishes, priorities, and values should he/she loses capacity. There remain unanswered questions as to whether healthcare professionals are supportive of a move towards better engagement in such discussions with patients. Even if the reception to the idea is positive, it is clear that appropriate training and understanding will be required. The aims of this review were to describe the current knowledge and attitudes of healthcare professionals towards advance care planning in the perioperative setting, and to outline any educational programmes or training limitations that have been identified. Seven articles that met the inclusion criteria were identified. They indicate that healthcare professionals mostly have a positive view of advance care planning in the perioperative period, and there is little training or educational content available. Despite this, most healthcare professionals report feeling well equipped to have such discussions. Evidence was not found of advance care planning becoming a routine part of training or practice in the care of patients in the lead up to high-risk surgery.

What previous generations called 'the art of dying' is undergoing a renaissance as an important aspect of healthcare delivery. In his recently published book, 'Being Mortal', 1 and accompanying Reith lectures, surgeon and author Atul Gawande has turned