title: Understanding advance care planning as a process of health behavior change.
abstract: OBJECTIVE
  To explore whether models of health behavior change can help to inform interventions for advance care planning (ACP).
  
  
  METHODS
  Qualitative cross-sectional study.
  
  
  METHODS
  Community.
  
  
  METHODS
  Sixty-three community-dwelling persons aged 65 and older and 30 caregivers with experience as surrogate decision-makers.
  
  
  METHODS
  In focus groups conducted separately with older persons and caregivers, participants were asked to discuss ways they had planned for future declines in health and why they had or had not engaged in such planning. Transcripts were analyzed using grounded theory.
  
  
  RESULTS
  Four themes illustrated the potential of applying models of health behavior change to improve ACP. (1) Participants demonstrated variable readiness to engage in ACP and could be in different stages of readiness for different components of ACP, including consideration of treatment goals, completion of advance directives, and communication with families and physicians. (2) Participants identified a wide range of benefits of and barriers to ACP. (3) Participants used a variety of processes of change to progress through stages of readiness, and ACP was only one of a broader set of behaviors that participants engaged in to prepare for declines in their health or for death. (4) Experience with healthcare decision-making for loved ones was a strong influence on perceptions of susceptibility and engagement in ACP.
  
  
  CONCLUSIONS
  The variability in participants' readiness, barriers and benefits, perceptions of susceptibility, and use of processes to increase readiness for participating in each component of ACP suggests the utility of customized, stage-specific interventions based on individualized assessments to improve ACP.
authors.affiliation: Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA. terri.fried@yale.edu
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
authors.forename: Karen
authors.initials: K
authors.lastname: Bullock
authors.forename: Lynne
authors.initials: L
authors.lastname: Iannone
authors.forename: John R
authors.initials: JR
authors.lastname: O'Leary
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D015577:Geriatric Assessment; D006040:Goals; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D020377:Self Efficacy
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