title: Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study.
abstract: To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings.
  
  
  
  A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings.
  
  
  
  A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres.
  
  
  
  We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no).
  
  
  
  196 patients (38-96 years old, 50.5% women) participated. Mean (±SD) time to administer was 48.8±19.6 min. Mean acceptability scores ranged from 3.2±1.3 in hospital to 4.7±0.9 in primary care, and mean relevance ranged from 3.5±1.0 in hospital to 4.9±0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1±0.6 and the mean action score was 11.2±5.6 (of a possible 25).
  
  
  
  The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Howard
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Bonham
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada Department of Public Health, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California, USA Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sudore
authors.affiliation: Covenant Health Palliative Institute, Edmonton, Alberta, Canada.
authors.forename: Konrad
authors.initials: K
authors.lastname: Fassbender
authors.affiliation: School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Robinson
authors.affiliation: Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: McKenzie
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Dawn
authors.initials: D
authors.lastname: Elston
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002908:Chronic Disease / Q000628:therapy; D003430:Cross-Sectional Studies; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: advance care planning; communication; measurement; survey