Socio-demographic and clinical factors affecting advance care planning: results from a large community cohort in NSW, Australia

Ella Yang; Alamgir Kabir; Joel Rhee; Cathy O'Callaghan; Margo Barr

Just Accepted

This article has been peer reviewed and accepted for publication. It is in production and has not been edited, so may differ from the final published form.

Socio-demographic and clinical factors affecting advance care planning: results from a large community cohort in NSW, Australia

Ella Yang, Alamgir Kabir, Joel Rhee, Cathy O'Callaghan , Margo Barr

Abstract

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 formally completing 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 socio-demographic and clinical predictors of individuals engaging with ACP and ACDs using data from the 45 and Up Study cohort in NSW. Methods: A cross-sectional cohort study of 28626 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: We identified 28,626 people completed the ACP/ACD related questions, of whom 17,458 (61%) completed ACP and 3,744 (13.1%) completed ACD. The predictors associated with an increased likelihood of completing 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 healthcare concession 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.

AH24327 Accepted 09 March 2025