title: Are Canadians providing advance directives about health care and research participation in the event of decisional incapacity?
abstract: OBJECTIVE
  Advance planning for health care and research participation has been promoted as a mechanism to retain some control over one's life, and ease substitute decision making, in the event of decisional incapacity. Limited data are available on Canadians' current advance planning activities. We conducted a postal survey to estimate the frequency with which Canadians communicate their preferences about health care and research should they become incapacitated.
  
  
  METHODS
  We surveyed 5 populations (older adults, informal caregivers, physicians, researchers in aging, and research ethics board members) from Nova Scotia, Ontario, Alberta, and British Columbia. We asked respondents whether they had expressed their preferences regarding a substitute decision maker, health care, and research participation in the event of incapacity.
  
  
  RESULTS
  Two out of 3 respondents (62.0%; 95% CI 59.1% to 64.8%) had been advised to communicate their health care preferences in advance. Oral expression of wishes was reported by 69.1% of respondents (95% CI 66.8% to 71.3%), and written expression by 46.7% (95% CI 44.3% to 49.2%). Among respondents who had expressed wishes in advance (orally or in writing), 91.2% had chosen a substitute decision maker, 80.9% had voiced health care preferences, and 19.5% had voiced preferences regarding research participation. Having been advised to communicate wishes was a strong predictor of the likelihood of having done so.
  
  
  CONCLUSIONS
  Advance planning has increased over the last 2 decades in Canada. Nonetheless, further efforts are needed to encourage Canadians to voice their health care and research preferences in the event of incapacity. Physicians are well situated to promote advance planning to Canadians.
authors.affiliation: Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Quebec. Gina.Bravo@USherbrooke.ca
authors.forename: Gina
authors.initials: G
authors.lastname: Bravo
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Dubois
authors.forename: Carole
authors.initials: C
authors.lastname: Cohen
authors.forename: Sheila
authors.initials: S
authors.lastname: Wildeman
authors.forename: Janice
authors.initials: J
authors.lastname: Graham
authors.forename: Karen
authors.initials: K
authors.lastname: Painter
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bellemare
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000941:ethics / Q000458:organization & administration / Q000706:statistics & numerical data; D024362:Advance Directive Adherence / Q000592:standards; D016223:Advance Directives / Q000941:ethics / Q000523:psychology; D000368:Aged; D001291:Attitude of Health Personnel; D026688:Bioethical Issues; D002170:Canada; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010344:Patient Advocacy; D010358:Patient Participation / Q000523:psychology; D028701:Patient Rights; D018579:Patient Selection / Q000941:ethics*; D010817:Physician-Patient Relations / Q000941:ethics