Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study
Authors : Michelle Howard, Aaron J Bonham, Daren K Heyland, Rebecca Sudore, Konrad Fassbender, Carole A Robinson, Michael McKenzie, Dawn Elston, John J You
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.
Citation: Michelle Howard, Aaron J Bonham, Daren K Heyland, Rebecca Sudore, Konrad Fassbender, Carole A Robinson, Michael McKenzie, Dawn Elston, John J You Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study BMJ Open 2016;6:e010375 doi:10.1136/bmjopen-2015-010375
Received 26 October 2015 Revised 20 April 2016 Accepted 10 May 2016 Published 23 June 2016
Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Collaborators
Roy Ilan, Ingrid Brenner, Gillian Fyles, Marissa Slaven, Carol Mantle, Marilyn Swinton, Maureen Douglas.
Contributors
AJB involved in analysis and interpretation of data, drafting of manuscript and critical revision. DE participated in acquisition of data, interpretation of data and critical revision. KF involved in study conception and design, acquisition of data, interpretation of data and critical revision. DKH involved in study conception and design, interpretation of data and critical revision. MH involved in study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript and critical revision. MM involved in study conception and design, acquisition of data, interpretation of data and critical revision. CAR involved in study conception and design, acquisition of data, interpretation of data and critical revision. RS involved in study conception and design, interpretation of data and critical revision. JJY involved in study conception and design, acquisition of data, interpretation of data and critical revision. All authors approved the final submitted manuscript.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
