title: Knowledge, attitudes, and preferences of healthy young adults regarding advance care planning: a focus group study of university students in Pittsburgh, USA.
abstract: BACKGROUND
  To date, research and promotion regarding advance care planning (ACP) has targeted those with serious illness or the elderly, thereby ignoring healthy young adults. The purpose of this study was to explore young adults' knowledge, attitudes, and preferences regarding advance care planning (ACP) and medical decision-making. Further, we aimed to understand the potential role of public health to encourage population-based promotion of ACP.
  
  
  METHODS
  Between February 2007 and April 2007, we conducted six focus groups comprising 56 young adults ages 18-30. Topics explored included (1) baseline knowledge regarding ACP, (2) preferences for ACP, (3) characteristics of preferred surrogates, and (4) barriers and facilitators to completing ACP specific to age and individuation. We used a qualitative thematic approach to analyze transcripts.
  
  
  RESULTS
  All participants desired more information regarding ACP. In addition, participants expressed (1) heterogeneous attitudes regarding triggers to perform ACP, (2) the opinion that ACP is a marker of individuation, (3) the belief that prior exposure to illness plays a role in prompting ACP, and (4) an appreciation that ACP is flexible to changes in preferences and circumstances throughout the life-course.
  
  
  CONCLUSIONS
  Young adults perceive ACP as a worthwhile health behavior and view a lack of information as a major barrier to discussion and adoption. Our data emphasize the need for strategies to increase ACP knowledge, while encouraging population-level, patient-centered, healthcare decision-making.
authors.affiliation: Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA. diok@pitt.edu.
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. nce4@pitt.edu.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Ernecoff
authors.affiliation: School of Nursing, University of Virginia, Charlottesville, VA, USA. jlk2t@virginia.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Keim-Malpass
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. degen@pitt.edu.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Degenholtz
mesh_terms: D000293:Adolescent; D000328:Adult; D032722:Advance Care Planning; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010414:Pennsylvania; D036301:Qualitative Research; D013334:Students / Q000523:psychology*; D014495:Universities; D055815:Young Adult