Sociodemographic and clinical factors affecting advance care planning: results from a large community cohort in New South Wales, Australia

E. Yang; A. Kabir; J. Rhee; C. O’Callaghan; M. Barr

doi:10.1071/AH24327

RESEARCH ARTICLE (Open Access)

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Sociodemographic and clinical factors affecting advance care planning: results from a large community cohort in New South Wales, Australia

E. Yang ^A , A. Kabir ^B , J. Rhee ^C , C. O’Callaghan

^D ^* and M. Barr

^D

+ Author Affiliations

- Author Affiliations

^A School of Population Health, Faculty of Medicine and Health, UNSW, Level 3, AGSM Building, Sydney, NSW 2052, Australia.

^B The George Institute for Global Health, UNSW, Sydney, NSW, Australia.

^C Discipline of General Practice, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, NSW 2052, Australia.

^D International Centre for Future Health Systems (ICFHS), Faculty of Medicine and Health, UNSW, Level 3, AGSM Building, NSW 2052, Australia.

^* Correspondence to: c.ocallaghan@unsw.edu.au

Australian Health Review 49, AH24327 https://doi.org/10.1071/AH24327

Submitted: 23 November 2024 Accepted: 9 March 2025 Published: 8 April 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objectives

The ageing population and increasing chronic illness pose significant healthcare challenges, including care late in life. Advance care planning (ACP) is an ongoing process of making decisions regarding future health care for patients. This process can include formal completion of an advance care directive (ACD), which is a legally binding document. ACP can improve patient outcomes and satisfaction, but rates are low across Australia. This study assessed the sociodemographic and clinical predictors of individuals engaging with ACP and ACDs using data from the 45 and Up Study cohort in New South Wales.

Methods

A cross-sectional cohort study of 28,626 people responded to ACP-related questions in the wave 2 questionnaire of the Sax Institute’s 45 and Up Study. ACP completion was recorded if people responded ‘yes’ to any of the three ACP questions, and ACD was recorded if they responded ‘yes’ to the ACD question. Poisson regression modelling was used to estimate the prevalence ratio and the 95%CI.

Results

A total of 28,626 people completed the ACP- and/or ACD-related questions, of whom 17,458 (61%) completed ACP and 3744 (13.1%) completed ACD. The predictors associated with an increased likelihood of ACP and ACD completion included having a will, advancing age, being female, having private health insurance, not currently working, and having one or more self-reported medical conditions. Predictors unique to increased overall ACP completion included having a university degree or higher, being married and having a health care concession card (Health Care Card). Being a carer increased ACD rates, whereas being married or in a de facto relationship decreased ACD completion.

Conclusions

These findings could inform interventions aimed at improving ACP uptake by identifying groups that engage less in ACP and provide a basis for future research.

Keywords: advance care planning, advance care directive, associations, cohort, chronic care, survey.

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