Association of experience with illness and end-of-life care with advance care planning in older adults

Objectives: To examine whether experiences with illness and end-of-life care are associated with readiness to participate in advance care planning (ACP).

Design: Observational cohort study.

Setting: Community.

Participants: Persons aged 60 and older recruited from physician offices and a senior center.

Measurements: Participants were asked about personal experience with major illness or surgery and experience with others' end-of-life care, including whether they had made a medical decision for someone dying, knew someone who had a bad death due to too much or too little medical care, or experienced the death of a loved one who made end-of-life wishes known. Stages of change were assessed for specific ACP behaviors: completion of living will and healthcare proxy, communication with loved ones regarding life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same topics. Stages of change included precontemplation, contemplation, preparation, and action or maintenance, corresponding to whether the participant was not ready to complete the behavior, was considering participation in the next 6 months, was planning participation within 30 days, or had already participated.

Results: Of 304 participants, 84% had one or more personal experiences or experience with others. Personal experiences were not associated with greater readiness for most ACP behaviors. In contrast, having one or more experiences with others was associated with greater readiness to complete a living will and healthcare proxy, discuss life-sustaining treatment with loved ones, and discuss quantity versus quality of life with loved ones and with physicians.

Conclusion: Older individuals who have experience with end-of-life care of others demonstrate greater readiness to participate in ACP. Discussions with older adults regarding these experiences may be a useful tool in promoting ACP.