BACKGROUND AND OBJECTIVES: The development of advance care plans (Plans) in general practice can be time consuming. End-of-life care should reflect an individual’s documented preferences. The aim of this study was to examine the content and implementation of Plans in hospital during end-of-life care. METHODS: A retrospective cohort study of the hospital medical records of decedents aged ≥75 years was performed to assess Plan content and implementation. RESULTS: Of the 536 decedents, 52 had a Plan. There were 17 cases where life-prolonging treatment was given and contradicted preferences listed in the Plan. This included instances of intubation, surgery and curative medication. DISCUSSION: General practice staff investment in advance care planning should be reflected in the utilisation of Plans and, where medically indicated, respect for patients’ preferences.