• Ben P White, Lindy Willmott, Cheryl Tilse, Jill Wilson, Michele Ferguson, Joanne Aitken, Jeffrey Dunn, Deborah Lawson, Angela Pearce, and Rachel Feeney.
• Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia.
• Intern Med J. 2019 Oct 1; 49 (10): 1261-1267.

BackgroundThe community prevalence of advance care directives (ACD) is low despite known benefits of advance care planning for patients, families and health professionals.AimTo determine the community prevalence of instructional and appointing ACD in New South Wales, Victoria and Queensland and factors associated with completion of these documents.MethodsA telephone survey of adults living in New South Wales, Victoria and Queensland (n = 1175) about completion of instructional ACD (making their own decisions about future healthcare) and appointing ACD (appointing another to decide). Quota sampling occurred based on population size by state, gender and age, with oversampling in smaller jurisdictions (Victoria and Queensland).ResultsOverall response rate was 33%. Six per cent of respondents reported completing an instructional ACD while 12% reported completing an appointing ACD. Female gender, higher educational level, personal experience of a major health scare and being widowed were significant predictors of completing an instructional ACD. Older age, higher educational level and being widowed were significant predictors of completing an appointing ACD.ConclusionsDespite long-standing efforts to increase advance care planning, community prevalence of ACD remains low, particularly for instructional ACD. This study found some different predictors for instructional ACD compared with appointing ACD, and also a potential role for experiential factors in triggering uptake. These findings suggest supplementing general community awareness campaigns with more nuanced and targeted efforts to improve ACD completion.© 2019 Royal Australasian College of Physicians.

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