![]() To the authors’ knowledge, no other studies have examined how other demographic and clinical characteristics relate to ACP as a process of behaviour change.Īs ACP is a process of communication, factors pertaining to how GPs, who play a pivotal role in initiating ACP because of their accessibility and continuity of care, 5, 25 communicate with the patient should also be considered. 24 In a validation of the Dutch 34-item ACP Engagement Survey, patients aged ≥60 years and with chronic disease showed higher engagement 22 however, the study did not compare engagement within the chronic illness category (cancer and non-cancer diseases). ![]() 23 Using this survey it has been found that patients with depression or anxiety have higher engagement. 16, 23 Based on these theoretical foundations, the ACP Engagement Survey has been developed to measure behaviour change processes (knowledge, contemplation, self-efficacy, and readiness) and actions (for example, whether discussions have occurred). Behaviour change theory and social cognitive theory have been used to describe processes underlying ACP engagement, including self-efficacy (that is, how confident the patient feels to complete the behaviour) and readiness (that is, the patient’s stage of behaviour change). In comparison, studies that examine ACP as a behaviour change process, instead of discrete actions as described above, are fewer. 12, 14 Examples of other factors that may correlate with ACP actions include religious beliefs and religiosity, 8, 14, 17 – 19 educational attainment, 8, 13, 14, 17, 20 marital status, 19, 21 and physical functioning. 16 Female sex has been found to be associated with having discussions about end-of-life care wishes, 6, 8, 17 but findings regarding completion of ACP documents are mixed. Increasing age has been found not only to be associated with increased likelihood of having ACP documentation 12 – 15 but also with a decreased likelihood of discussing ACP with family and friends. 11Įvidence from the literature about which personal characteristics are associated with ACP engagement has mainly focused on whether ACP actions are performed. 10 For patients with cancer specifically, GPs in Belgium are aware of patient preferences for treatment at the end of life in approximately one-half of cases, and of patient preferences for a surrogate decision maker in less than one-third of cases. ![]() ![]() 6 – 9 This has also been found in Belgium, where the prevalence of advance directives to withhold or withdraw treatment is low for patients who are terminally ill. 3 Although studies show that adults in the community as well as patients think about and are open to ACP, 4, 5 conversations and corresponding documentation remain infrequent. ![]() 2 ACP is a complex process of communication and decision making, which includes actions such as contemplating care wishes, having conversations about values and care preferences with family and health providers, completing advance directives for future care, and revisiting these actions over time. 1 Advance care planning (ACP) can reduce this discrepancy by promoting communication and understanding of patients’ values and preferences for future (end-of-life) care before loss of decisional capacity. Patients with chronic, life-limiting illness often still receive medical care that does not align with their values and preferences. ![]()
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