Promoting advance care planning among community-based older adults: A randomized controlled trial.
To test an intervention designed to motivate older adults in documenting their healthcare preferences in advance, and to guide proxies in making hypothetical decisions that match those of the older adult.



The trial involved 235 older adults, of which half were assisted in communicating their wishes to their proxy. Hypothetical vignettes were used at baseline and twice after the intervention to elicit older adults' preferences and assess their proxy's ability to predict them.



By the end of the trial, 80% of older adults allocated to the experimental group had documented their wishes. Changes over time in mean accuracy scores did not differ between groups for any hypothetical situations, except when limiting the sample to dyads that were highly discordant at baseline.



The intervention motivated a large proportion of older adults to express their preferences but had little effect on proxies' ability to predict them.



Educational tools developed for this study will assist healthcare providers in helping older adults to record their wishes in advance. Clients must be informed of the challenge of making substitute decisions and of the need to discuss the amount of leeway the proxy should have in interpreting expressed wishes.
Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada; Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada. Electronic address: Gina.Bravo@USherbrooke.ca.
Gina
G
Bravo
Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada.
Lise
L
Trottier
Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada; Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.
Marcel
M
Arcand
Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.
Anne-Marie
AM
Boire-Lavigne
Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada; Department of Accounting Sciences, Faculty of Business Administration, Université de Sherbrooke, Sherbrooke, Canada.
Danièle
D
Blanchette
Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada; Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada.
Marie-France
MF
Dubois
Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada; Charles-LeMoyne Hospital Research Centre, Longueuil, Canada.
Maryse
M
Guay
Department of Coordination and Academic Affairs, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada.
Julie
J
Lane
Department of Psychiatry, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.
Paule
P
Hottin
Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada.
Suzanne
S
Bellemare
D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D057240:Patient Preference; D019727:Proxy; D012111:Residence Characteristics
Accuracy; Advance directives; Clinical vignettes; Competence; Completion rate; Substitute decision-making