Older patient engagement in advance care planning in Canadian primary care practices: Results of a multisite survey

Michelle Howard; Carrie Bernard; Doug Klein; Amy Tan; Marissa Slaven; Doris Barwich; John J. You; Gabriel Asselin; Jessica Simon; Daren K. Heyland

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Table 1.

Characteristics of participating family practices in the 3 provinces and national comparisons

CHARACTERISTIC	ALBERTA (N = 6), N (%)	BRITISH COLUMBIA (N = 2), N (%)	ONTARIO (N = 12), N (%)	TOTAL (N = 20), N (%)	*CANADA,^ %**
Type of practice
• Group	6 (100.0)	2 (100.0)	9 (75.0)	17 (85.0)	81.3^†
• Solo	0 (0.0)	0 (0.0)	3 (25.0)	3 (15.0)	18.7^†
Teaching clinic	1 (16.7)	0 (0.0)	2 (16.7)	3 (15.0)	NA
Allied health professionals	6 (100.0)	1 (50.0)	10 (83.3)	17 (85.0)	19.1
Urban or suburban practice location	6 (100.0)	2 (100.0)	10 (83.3)	20 (100.0)	67.5

NA—not available.
↵* Canada-wide data from the National Physician Survey.^27,28
↵† Hospital-based practice data and nonresponses were excluded.

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Table 2.

Characteristics of patients from primary care practices: N = 810 unless otherwise specified.

CHARACTERISTIC	VALUE
Mean (SD) age, y	66 (10)
Age range, y	50 to 95
Female sex (N = 809), n (%)	450 (55.6)
Marital status (N = 809), n (%)
• Married or in a relationship	558 (69.0)
• Widowed	100 (12.4)
• Divorced or single	151 (18.7)
Lives alone (N = 809), n (%)	179 (22.1)
Urban residence (self-defined) (N = 806), n (%)	718 (89.1)
Highest level of education is some or completed postsecondary (N = 808), n (%)	500 (61.9)
Spirituality or religion is very or extremely important (N = 808), n (%)	365 (45.2)
Identifies with formal religious group or practice (N = 805), n (%)
• Protestant	295 (36.6)
• Catholic	194 (24.1)
• Other	136 (16.9)
• None	180 (22.4)
Identifies as Caucasian or white, n (%)	713 (88.0)
Speaks a language other than English or French on a daily basis (N = 807), n (%)	129 (16.0)
Self-reported health (N = 805), n (%)
• Excellent, very good, or good	661 (82.1)
• Fair or poor	144 (17.9)
Self-reported quality of life (N = 806), n (%)
• Excellent, very good, or good	736 (91.3)
• Fair or poor	70 (8.7)
Frailty index (N = 806), n (%)
• Very fit, well, or managing well	712 (88.3)
• Vulnerable or frail	94 (11.7)
Mean (SD) Charlson Comorbidity Index score	1 (1)
• Range	0 to 10

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Table 3.

Prevalence of ACP awareness and activities reported by the primary care patients: N = 810 unless specified otherwise.

QUESTION	N (%)
Have you ever thought about what kinds of medical treatments you would want or not want if you were to get very sick and be in a hospital?	555 (68.5)
Have you talked with anyone about what medical treatments you would want or not want at the end of life? If yes ... (N = 428)	428 (52.8)
• Family doctor	75 (17.5)
• Nurse	9 (2.1)
• Social worker	4 (0.9)
• Spiritual care worker	7 (1.6)
• Other doctor	16 (3.7)
• Family members	394 (92.1)
• Substitute decision maker	21 (4.9)
• Lawyer	100 (23.4)
• Other	26 (6.1)
Have you written down your wishes about medical treatments you would want or not want in the event you are unable to speak for yourself?	259 (32.0)
Have you named someone, in writing, to be your substitute decision maker for medical treatment decisions?	408 (50.4)
No. of ACP activities reported (N = 809)
• 0	152 (18.8)
• 1	154 (19.0)
• 2	199 (24.6)
• 3	118 (14.6)
• 4	186 (23.0)

ACP—advance care planning.

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Table 4.

Association between sociodemographic and health status variables and reporting engagement in all 4 advance care planning activities among 810 patients in primary care

VARIABLE	UNADJUSTED ODDS RATIO (95% CI)	ADJUSTED ODDS RATIO (95% CI)	P VALUE^*
Age (10-y categories)	1.61 (1.35 to 1.92)	1.55 (1.26 to 1.90)	< .001
Sex (female vs male)	0.96 (0.68 to 1.36)	1.04 (0.71 to 1.52)	.86
Marital status (married or in a relationship vs other)	0.58 (0.40 to 0.84)	0.67 (0.35 to 1.29)	.23
Lives alone (no vs yes)	0.51 (0.34 to 0.75)	0.91 (0.45 to 1.83)	.79
Location of residence (urban vs rural)	1.50 (0.82 to 2.72)	1.32 (0.70 to 2.46)	.39
Highest education (some or completed postsecondary education vs other)	1.00 (0.70 to 1.42)	1.26 (0.85 to 1.87)	.24
Spirituality or religion (very or extremely important vs other)	1.16 (0.82 to 1.65)	1.06 (0.72 to 1.57)	.76
Religious group			.33
• Catholic vs Protestant	1.30 (0.79 to 2.13)	1.27 (0.78 to 2.09)
• None vs Protestant	1.01 (0.63 to 1.61)	1.11 (0.67 to 1.85)
• Other vs Protestant	1.03 (0.65 to 1.65)	1.64 (0.96 to 2.80)
Ethnicity (white or Caucasian vs other)	1.27 (0.69 to 2.33)	1.21 (0.63 to 2.33)	.57
Speak language on a daily basis other than English or French (yes vs no)	0.73 (0.42 to 1.25)	0.64 (0.36 to 1.15)	.14
Self-reported health (excellent, very good, or good vs fair or poor)	0.94 (0.66 to 1.33)	1.13 (0.72 to 1.78)	.60
Self-reported quality of life (excellent, very good, or good vs fair or poor)	0.77 (0.54 to 1.09)	0.64 (0.40 to 1.01)	.06
Frailty index (vulnerable or worse vs other)	1.48 (0.90 to 2.44)	1.48 (0.84 to 2.59)	.18
Charlson Comorbidity Index score^†	1.18 (1.05 to 1.34)	1.09 (0.94 to 1.26)	.24