title: Association of experience with illness and end-of-life care with advance care planning in older adults.
abstract: OBJECTIVE
  To examine whether experiences with illness and end-of-life care are associated with readiness to participate in advance care planning (ACP).
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Community.
  
  
  METHODS
  Persons aged 60 and older recruited from physician offices and a senior center.
  
  
  METHODS
  Participants were asked about personal experience with major illness or surgery and experience with others' end-of-life care, including whether they had made a medical decision for someone dying, knew someone who had a bad death due to too much or too little medical care, or experienced the death of a loved one who made end-of-life wishes known. Stages of change were assessed for specific ACP behaviors: completion of living will and healthcare proxy, communication with loved ones regarding life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same topics. Stages of change included precontemplation, contemplation, preparation, and action or maintenance, corresponding to whether the participant was not ready to complete the behavior, was considering participation in the next 6 months, was planning participation within 30 days, or had already participated.
  
  
  RESULTS
  Of 304 participants, 84% had one or more personal experiences or experience with others. Personal experiences were not associated with greater readiness for most ACP behaviors. In contrast, having one or more experiences with others was associated with greater readiness to complete a living will and healthcare proxy, discuss life-sustaining treatment with loved ones, and discuss quantity versus quality of life with loved ones and with physicians.
  
  
  CONCLUSIONS
  Older individuals who have experience with end-of-life care of others demonstrate greater readiness to participate in ACP. Discussions with older adults regarding these experiences may be a useful tool in promoting ACP.
authors.affiliation: Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Halima
authors.initials: H
authors.lastname: Amjad
authors.forename: Virginia
authors.initials: V
authors.lastname: Towle
authors.forename: Terri
authors.initials: T
authors.lastname: Fried
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013727:Terminal Care
keywords: advance care planning; end-of-life care