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Can Fam Physician. 2018 May;64(5):371-377.

Older patient engagement in advance care planning in Canadian primary care practices: Results of a multisite survey.

Author information

1
Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont. mhoward@mcmaster.ca.
2
Assistant Clinical Professor in the Department of Family Medicine at McMaster University and Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario.
3
Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
4
Associate Professor in the Department of Family Medicine at the University of Calgary in Alberta.
5
Assistant Clinical Professor in the Division of Palliative Care at McMaster University.
6
Clinical Associate Professor in the Division of Palliative Care in the Department of Medicine at the University of British Columbia in Vancouver.
7
Associate Professor in the Department of Health Research Methods, Evidence and Impact and the Department of Medicine at McMaster University.
8
Research associate in the Department of Family Medicine at the University of Alberta at the time of writing.
9
Associate Professor in the Division of Palliative Medicine at the University of Calgary.
10
Professor in the Department of Critical Care Medicine and the Department of Public Health Sciences at Queen's University in Kingston, Ont, and Director of the Clinical Evaluation Research Unit at Kingston General Hospital.

Abstract

OBJECTIVE:

To assess primary care patients' engagement in advance care planning (ACP) and predictors of engagement.

DESIGN:

Cross-sectional survey using a revised version of a validated questionnaire.

SETTING:

Alberta, Ontario, and British Columbia.

PARTICIPANTS:

Convenience sample of 20 family practices that provided a consecutive sample of 810 patients aged 50 years and older.

MAIN OUTCOME MEASURES:

Engagement in ACP activities, and sociodemographic and health-related predictors of having engaged in ACP activities.

RESULTS:

Patients had a mean age of 66 years (55.6% women). Two-thirds of patients (68.5%; 555) had thought about the kinds of medical treatments they would want or not want if they were sick and in hospital, 52.8% (n = 428) had talked with someone about what they would want, 32.0% (n = 259) had written down their wishes, 50.4% (n = 408) had named someone to be their substitute decision maker, and 23.0% (n = 186) had engaged in all 4 key ACP activities. Of those patients who had talked to someone about medical treatments wanted or not, 17.5% (n = 75) had talked to their family doctors. Age (adjusted odds ratio per 10-year category of 1.55; 95% CI 1.26 to 1.90; P < .001) was significantly associated with having engaged in all ACP activities.

CONCLUSION:

Many patients have engaged in some ACP activities, but few have discussed ACP with their family physicians. Strategies should be implemented in primary care to reduce the barriers to discussing ACP.

PMID:
29760260
PMCID:
PMC5951655

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