What do Canadians think of advanced care planning? Findings from an online opinion poll

Abstract

BackgroundAdvance care planning (ACP) has the potential to increase patient-centred care, reduce caregiver burden, and reduce healthcare costs at the end of life. Current levels of public participation in ACP activities are unknown. The purpose of this study was to determine the level of engagement of average Canadians in ACP activities.MethodsData come from an on-line opinion poll of a national sample of respondents who were asked five questions on ACP activities along with their sociodemographic characteristics.ResultsRespondents were from all provinces of Canada, 52% were women, and 33% were between 45 years and 54 years of age. Of 1021 national sample respondents, 16% were aware of the term, ACP (95% CI 13% to 18%), 52% had discussions with their family or friends (95% CI 49% to 55%), and 10% had discussions with healthcare providers (95% CI 8% to 12%). Overall, 20% (95% CI 18% to 22%) of respondents had a written ACP and 47% (95% CI 44% to 50%) had designated a substitute decision maker. Being older was associated with significantly more engagement in ACP activities and there were significant differences in ACP engagement across Canada.ConclusionsAlthough only a small proportion of Canadians are aware of the formal term, ACP, a higher percentage of Canadians are actually engaged in ACP, through either having discussions or making decisions about end-of-life care. Older citizens are more likely to be engaged in ACP and there are geographic differences in the level of ACP engagement across Canada.

Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013

“…Health system policies and programmes may impact patient involvement in ACP,32 but the lack of apparent diffusion into public engagement has also been found in two others studies. The 2012 National poll found inconclusive differences in ACP engagement between Fraser Health Authority (a regional health system that has been conducting ACP engagement activities since 2004) and the rest of Canada 9. Similarly, Moorman et al 33 found no evidence of ‘social diffusion’ of ACP activities in La Crosse, Wisconsin, where the Respecting Choices ACP programme has been implemented since 1991.…”

“…This 2012 National poll had no self-rated health assessment but age, gender and education demographics were obtained. Teixeira et al 9 have published details of the poll method and findings. The data were weighted to ensure the sample’s age/gender composition reflects that of the adult Canadian population according to Census data.…”

“…For example, ‘advance directives’ or living wills were first used in the 1960s but the broader concept of ACP, emphasising (1) conversations as the way to ensure that preferences are interpreted appropriately and (2) the systematic implementation of ACP frameworks across healthcare or public contexts is still developing 2. Despite an increasing international consensus on the benefits of ACP,6 low levels of public engagement remain a concern 9. A meta-analysis in the palliative care context10 and cross-sectional studies of the public11 12 have explored the reasons for this, but there is a paucity of longitudinal data about whether public engagement in ACP activities is changing over time 13 14.…”

Am I Dying Doctor?": How End-Of-Life Care is Portrayed in Television Medical Dramas

“…In fact, regardless of the presented scenario, about 70% do not want CPR or mechanical ventilation in these situations [41]. However, the documentation rate of preferences for end-of-life care in the general population is still low [6]. Perhaps videos which have been developed for more educational purposes will affect the completion of advance directives rather than television medical dramas.…”

“…Most patients will not initiate these discussions and will wait for their physician to initiate end-of-life discussions, especially when patients were unaware about the life-threatening nature of their disease [5] or had little knowledge of ACP [6]. Indeed, lack of patient knowledge and understanding of medical information are physicianreported barriers for ACP [7].…”