title: Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013.
abstract: BACKGROUND
  Advance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.
  
  
  METHODS
  Raw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.
  
  
  RESULTS
  Statistically significant increases were observed between 2007 and 2013 in: recognising the definition of ACP (54.8% to 80.3%, OR 3.37 (95% CI 2.68 to 4.24)), discussions about healthcare preferences with family (48.4% to 59.8%, OR 1.41 (95% CI 1.17 to 1.69)) and with healthcare providers (9.1% to 17.4%, OR 1.98 (95% CI 1.51 to 2.59)), written ACP plans (21% to 34.6%, OR 1.77 (95% CI 1.45 to 2.17)) and legal documentation (23.4% to 42.7%, OR 2.13 (95% CI 1.75 to 2.59)). These remained significant after adjusting for age, education and self-rated health status.
  
  
  CONCLUSIONS
  ACP engagement increased over time, although the overall frequency remains low in certain elements such as discussing ACP with healthcare providers. We discuss factors that may be responsible for the increase and provide suggestions for healthcare systems or other public bodies seeking to stimulate engagement in ACP.
authors.affiliation: Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: J E
authors.initials: JE
authors.lastname: Simon
authors.affiliation: Department of Medical Oncology, Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada.|Alberta Health Services-Cancer Control.
authors.forename: S
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Clinical Evaluation Research Unit, Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada.|Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Heyland
authors.affiliation: Health Quality Council of Alberta, Calgary, Alberta, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Cooke
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Davison
authors.affiliation: Department of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Holroyd-Leduc
authors.affiliation: Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada.|John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Wasylenko
authors.affiliation: Department of Cardiac Sciences, University of Calgary, and Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Howlett
authors.affiliation: Covenant Health Palliative Institute, Edmonton, Alberta, Canada.|Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Fassbender
mesh_terms: D000293:Adolescent; D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data* / Q000639:trends*; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D003256:Community Participation / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Communication; Service evaluation