Advance care planning engagement in chronic, life-limiting illness: cluster-RCT baseline findings

Background: Advance care planning (ACP) has been characterized as a complex process of communication and decision-making. For ACP behavior change, underlying processes such as self-efficacy and readiness are needed. However, studies of which patient characteristics are associated with ACP have mainly focused on whether ACP actions are completed, leaving behavior change processes unexplored. Aim: To assess whether patients’ characteristics, and patient-perceived GP ACP communication, are associated with patient’s ACP engagement. Design and Setting: Baseline data from the ACP-GP cluster-randomized controlled trial in patients with chronic, life-limiting illness (n=95). Method: Patients completed questionnaires for demographic and clinical characteristics, and for perception of the GP’s ACP information provision and listening. Engagement was measured using the 15-item ACP Engagement Survey, with self-efficacy and readiness subscales. Linear mixed models tested associations with engagement. Results: Demographic and clinical characteristics were not associated with engagement; nor ratings of how much ACP information they received from the GP; the extent to which the GP listened to what was important for the patient to live well, or listened to what was important to the patient regarding future care. Higher overall ACP engagement (p=.002) and self-efficacy (p<.001) were observed in patients who gave a high rating for the extent to which their GP listened to their worries regarding future health. Conclusion: Our study suggests that GPs’ providing information about ACP alone is not associated with patients’ ACP engagement; an important element is to also listen to patients’ worries regarding their future health.