Individual, interpersonal, and health care factors associated with informal and formal advance care planning in a nationally-representative sample of midlife and older adults

Abstract

ObjectiveAssess correlates of advance care planning (ACP) among midlife and older adults in the United States, with attention to informal planning (e.g., conversations) and formal planning (e.g., legal documentation such as a living will). MethodsData were collected from a nationally-representative U.S. sample of adults ages 55–74. ResultsInformal ACP was positively associated with greater confidence, history of life-threatening illness, designation as health care decision maker for someone else, knowing at least one negative end-of-life (EOL) story in one’s personal network, a desire to ease surrogates’ decision making, and having a health care provider who had broached ACP. Formal ACP was positively associated with greater confidence, designation as a health care decision maker, having a provider who had broached ACP, and primarily receiving medical care from a doctor’s office, and marginally negatively associated with health worry. ConclusionsThere are relevant correlates of advance care planning at the individual, interpersonal, and health care levels, with implications for increasing uptake of ACP. Practice implicationsA desire to mitigate proxies’ decision-making burden was a significant motivator for ACP conversations. Awareness of negative EOL experiences may also motivate these conversations. Health care providers have a powerful role in formal and informal ACP uptake.