• J Pain Symptom Manage · Oct 2021

    Randomized Controlled Trial

    Understanding the Role of Knowledge in Advance Care Planning Engagement.

    • Laura I van Dyck, Andrea Paiva, Colleen A Redding, and Terri R Fried.
    • Department of Medicine, School of Medicine, Yale University (L.I.v.D., T.R.F.), New Haven, Connecticut, USA. Electronic address: laura.vandyck@yale.edu.
    • J Pain Symptom Manage. 2021 Oct 1; 62 (4): 778-784.

    ContextAdvance care planning remains underutilized. A better understanding of the role of education in promoting engagement is needed.ObjectivesTo examine advance care planning knowledge and its relationship to engagement in middle-aged and older adults.MethodsThis cross-sectional study utilized baseline data from 921 participants age ≥55 years enrolled in the STAMP randomized controlled trial, including a knowledge scale consisting of seven questions regarding the purpose and mechanisms of advance care planning and measures of participation.ResultsOnly 11.9% of participants answered all 7 questions correctly, and 25.6% of participants answered ≤3 correctly (defined as "low knowledge"). Low knowledge was independently associated with male gender (odds ratio [OR] 2.1, 95% confidence interval [CI]: 1.5, 3.0), non-white race (OR 1.5, 95% CI: 1.1, 2.2), older age (OR 2.2, 95% CI: 1.4, 3.4), lower income (OR 1.5, 95% CI: 1.1, 2.1), and lower education level (OR 2.9, 95% CI: 2.0, 4.1). Higher knowledge was independently associated with communicating with a loved one about quality versus quantity of life (OR 1.7, 95% CI: 1.2, 2.4) and with living will completion (OR 1.6, 95% CI: 1.0, 2.5), but not with healthcare agent assignment. Factors including race and education remained associated with engagement after accounting for knowledge.ConclusionKnowledge deficits regarding advance care planning are common and associated with the same sociodemographic factors linked to other healthcare disparities. While improving knowledge is an important component of intervention, it is unlikely sufficient in and of itself to increase engagement.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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