Advance care plans: planning for critical healthcare decisions

Abstract

Advance care plans (ACPs) document personal values and healthcare preferences for critical situations where individuals cannot speak for themselves. Although ACPs can prevent receiving costly unwanted treatments and ensure receiving preferred treatments, few people have one. We examine factors associated with ACP engagement and design interventions to increase engagement. We find that ACP holders and nonholders largely have common values and preferences, which similarly vary with demographics. For example, older (vs. younger) individuals, regardless of ACP ownership, prefer to be able to care for themselves and to avoid prolonged end-of-life medical interventions. These two groups also differ in important ways: those who have or intend to create ACPs (vs. not) prefer avoiding invasive life-sustaining treatments and having a peaceful end of life. However, interventions that use these similarities and differences to increase ACP engagement are unsuccessful. We propose that structural approaches may be more effective in increasing ACP uptake.