title: The balancing point: understanding uptake of advance directive forms in a rural Australian community.
abstract: OBJECTIVE
  The study was conducted in Western Australia, focusing on the attitudes of older, rural, non-hospitalised people towards newly legislated advance care planning (ACP) documents. This study explored baseline awareness and perception of advance directive (AD) forms and factors relevant to their utilisation, using the transtheoretical model as a theoretical framework.
  
  
  METHODS
  Sixty-two adults were recruited from residential aged care facilities, community care organisations, general practice, an oncology service and a law firm. Semi-structured interviews were undertaken. These were transcribed and thematically analysed by the authors.
  
  
  RESULTS
  Participants gave responses that were consistent with different stages of the transtheoretical model. Perceived susceptibility to the negative consequences of not engaging in AD form utilisation was a trigger for further contemplation. The presence of adequate personal empowerment was important for successful completion of AD forms. There was also qualitative evidence of a negative relationship between perceived susceptibility and empowerment regarding AD form utilisation.
  
  
  CONCLUSIONS
  Promoting balance between a person's perceived susceptibility and empowerment may be an effective method of increasing engagement with AD forms.
authors.affiliation: Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Sinclair
authors.forename: Kirsten Anne
authors.initials: KA
authors.lastname: Auret
authors.forename: Ashlee
authors.initials: A
authors.lastname: Burgess
mesh_terms: D016223:Advance Directives / Q000331:legislation & jurisprudence* / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001364:Awareness; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D012424:Rural Population; D014904:Western Australia
keywords: advance care planning; advance directive; empowerment; perceived susceptibility; transtheoretical