Wednesday, July 11, 2007
This presentation is part of : End-of-Life Strategies
Deciding to Engage in Advance Care Planning: A Comparison of Participants' Experiences
Karen J. Vander Laan, RN, MSN, PhD(c), Department of Nursing, Calvin College, Grand Rapids, MI, USA
Learning Objective #1: describe components of Advance Care Planning (ACP) as a dynamic decision-making process that helps people construct and communicate their end of life preferences.
Learning Objective #2: discuss the impact of personal influences, decision factors, and ACP experience on the decision to engage in ACP.

Advance care planning (ACP) is a dynamic decision-making process that assists people to construct and communicate their preferences for end of life care. Two decades of research have shown that when preferences are not known, undesirable outcomes may occur for individuals and other surrogate decision-makers. Barriers to advance planning can be addressed through educational programs, especially through existing community-based groups. However, research has not focused on ACP as a decision-making process. The purpose of this study was to examine internal and external influences within the decision-making context that may affect individuals’ decisions to engage and re-engage in ACP. The Decision Process Model for Advance Care Planning—synthesized by a transdisciplinary research team from previous models of ACP, decision-making theories, and experiences encountered in practice—provided the conceptual framework for this prospective descriptive quasi-experimental study. Study participants were 347 adults from existing community groups in the Midwestern United States who attended an ACP educational program provided by certified ACP Facilitators. Participants completed pre- and post-program Participant Surveys. Survey items were adapted from an ACP Program Quality Improvement Toolkit and independently reviewed for content validity and ease of use. The Pre-Program survey included personal influences on decision (information, individual characteristics, values, and prior experiences) and the personal decision factor self-efficacy (ability and likelihood to engage in ACP conversations). Participants’ perceptions of their information, values, and self-efficacy were rated again in the Post-Program survey. Results of this study describe the personal influence and decision factor variables associated with participants’ decisions to engage in ACP, the impact of an ACP educational intervention on personal influence and decision factor variables, and the role of ACP experience as a modifier of the decision to engage in ACP. Understanding influences on the decision to engage in ACP can help target community-based educational interventions to promote ACP.