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. 2019 Apr 24;19(1):118.
doi: 10.1186/s12877-019-1113-3.

Advance care planning dispositions: the relationship between knowledge and perception

Anne Cattagni Kleiner  1 , Brigitte Santos-Eggimann  2 , Sarah Fustinoni  2 , Anne-Véronique Dürst  3 , Katja Haunreiter  4 , Eve Rubli-Truchard  3   5 , Laurence Seematter-Bagnoud  2
Affiliations

Advance care planning dispositions: the relationship between knowledge and perception

Anne Cattagni Kleiner et al. BMC Geriatr. .

Abstract

Background: Legal dispositions for advance care planning (ACP) are available but used by a minority of older adults in Switzerland. Some studies found that knowledge of and perception of those dispositions are positively associated with their higher usage. The objective of the present study is to test the hypothesis of an association between increased knowledge of ACP dispositions and a more positive perception of them.

Methods: Data collected in 2014 among 2125 Swiss community-dwellers aged 71 to 80 of the Lausanne cohort 65+ (Lc65+), a population-based longitudinal study on aging and frailty. Data collection was conducted through a questionnaire on knowledge, use and perception of lasting power of attorney, advance directives and designation of a health care proxy. Covariables were extracted from the Lc65+ database. Bivariable and multivariable regression analyses assessed the association between level of knowledge and perception.

Results: Half the participants did not know about legal dispositions for ACP; filing rates were 14% for advance directives, 11% for health care proxy and 6% for lasting power of attorney. Level of knowledge about the dispositions was associated with a more positive perception of them, even when adjusting for confounding factors.

Conclusion: Although the direction of the association's causality needs more investigation, results indicate that better knowledge on ACP dispositions could improve the perception older people have of them. Communication on dispositions should take into account individual knowledge levels and address commonly enunciated barriers that seem to diminish with increased knowledge.

Keywords: Advance care planning; Advance directives; Health care proxy; Knowledge; Perception.

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Conflict of interest statement

Ethics approval and consent to participate

According to Swiss Federal Law 118b on human subject research (C.f. http://cer-vd.ch/soumission/premiers-pas.html), this study did not require the approval of an ethics committee, due to the type of data collected and its method of collect. The data collection process was entirely anonymous. The types of questions asked could not bring up any singular information that would make participants identifiable in the database and the results are presented in an aggregate manner. Participants could freely choose not to participate, no incentives were linked to their participation and there was no risk associated with taking part in the survey.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Percentage of individuals selecting each statement, by level of knowledge of ACP dispositions. Note: Chi square p values < 0.001 for all comparisons
Fig. 2
Fig. 2
Associationsƚ between agreeing with diverse statements regarding lasting power of attorney (LPOA) and level of knowledge about this disposition (OR and 95% CI, reference: no knowledge). ƚOdd ratios from multivariable regression analysis adjusted for the following covariables: gender; age group; educational level; living arrangement; number of children; born in the country; financial status; self-rated health; functional status; memory or concentration impairments; depression or anxiety symptoms; number of self-reported active chronic diseases; fear for own health; in the past 5 years: death of a loved one, difficulty in obtaining professional help or care or becoming a caretaker for a loved one, serious illness/accidents oneself/loved one, none of the events above; importance of spirituality, and communication with doctors. ǂWald test’s p value of the difference between ORs (knowledge – partial knowledge). *p < 0.05, **p < 0.01, ***p < 0.001
Fig. 3
Fig. 3
Associationsƚ between agreeing with diverse statements regarding advance directives (AD) and level of knowledge about this disposition (OR and 95% CI, reference: no knowledge). ƚOdd ratios from multivariable regression analysis adjusted for the following covariables: gender; age group; educational level; living arrangement; number of children; born in the country; financial status; self-rated health; functional status; memory or concentration impairments; depression or anxiety symptoms; number of self-reported active chronic diseases; fear for own health; in the past 5 years: death of a loved one, difficulty in obtaining professional help or care or becoming a caretaker for a loved one, serious illness/accidents oneself/loved one, none of the events above; importance of spirituality, and communication with doctors. ǂWald test’s p value of the difference between ORs (knowledge – partial knowledge). *p < 0.05, **p < 0.01, ***p < 0.001
Fig. 4
Fig. 4
Associationsƚ between agreeing with diverse statements regarding having a health care proxy (HCP) and level of knowledge about this disposition (OR and 95% CI, reference: no knowledge). ƚOdd ratios from multivariable regression analysis adjusted for the following covariables: gender; age group; educational level; living arrangement; number of children; born in the country; financial status; self-rated health; functional status; memory or concentration impairments; depression or anxiety symptoms; number of self-reported active chronic diseases; fear for own health; in the past 5 years: death of a loved one, difficulty in obtaining professional help or care or becoming a caretaker for a loved one, serious illness/accidents oneself/loved one, none of the events above; importance of spirituality, and communication with doctors. ǂWald test’s p value of the difference between ORs (knowledge – partial knowledge).. *p < 0.05, **p < 0.01, ***p < 0.001
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