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Multicenter Study
. 2016 Jun 23;6(6):e010375.
doi: 10.1136/bmjopen-2015-010375.

Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study

Michelle Howard  1 , Aaron J Bonham  2 , Daren K Heyland  3 , Rebecca Sudore  4 , Konrad Fassbender  5 , Carole A Robinson  6 , Michael McKenzie  7 , Dawn Elston  1 , John J You  8
Affiliations
Multicenter Study

Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study

Michelle Howard et al. BMJ Open. .

Abstract

Objectives: To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings.

Setting: A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings.

Participants: A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres.

Outcomes: We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no).

Results: 196 patients (38-96 years old, 50.5% women) participated. Mean (±SD) time to administer was 48.8±19.6 min. Mean acceptability scores ranged from 3.2±1.3 in hospital to 4.7±0.9 in primary care, and mean relevance ranged from 3.5±1.0 in hospital to 4.9±0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1±0.6 and the mean action score was 11.2±5.6 (of a possible 25).

Conclusions: The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate.

Keywords: advance care planning; communication; measurement; survey.

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