Understanding the Role of Knowledge in Advance Care Planning Engagement.

van Dyck LI, Paiva A, Redding CA, Fried TR. Understanding the Role of Knowledge in Advance Care Planning Engagement. Journal of pain and symptom management. 2021 Oct 1; 62(4):778-784.

Related HSR&D Project(s)

• IIR 15-312 – Promoting Advance Care Planning as a Healthy Behavior

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

CONTEXT: Advance care planning remains underutilized. A better understanding of the role of education in promoting engagement is needed. OBJECTIVES: To examine advance care planning knowledge and its relationship to engagement in middle-aged and older adults. METHODS: This cross-sectional study utilized baseline data from 921 participants age = 55 years enrolled in the STAMP randomized controlled trial, including a knowledge scale consisting of seven questions regarding the purpose and mechanisms of advance care planning and measures of participation. RESULTS: Only 11.9% of participants answered all 7 questions correctly, and 25.6% of participants answered = 3 correctly (defined as "low knowledge"). Low knowledge was independently associated with male gender (odds ratio [OR] 2.1, 95% confidence interval [CI]: 1.5, 3.0), non-white race (OR 1.5, 95% CI: 1.1, 2.2), older age (OR 2.2, 95% CI: 1.4, 3.4), lower income (OR 1.5, 95% CI: 1.1, 2.1), and lower education level (OR 2.9, 95% CI: 2.0, 4.1). Higher knowledge was independently associated with communicating with a loved one about quality versus quantity of life (OR 1.7, 95% CI: 1.2, 2.4) and with living will completion (OR 1.6, 95% CI: 1.0, 2.5), but not with healthcare agent assignment. Factors including race and education remained associated with engagement after accounting for knowledge. CONCLUSION: Knowledge deficits regarding advance care planning are common and associated with the same sociodemographic factors linked to other healthcare disparities. While improving knowledge is an important component of intervention, it is unlikely sufficient in and of itself to increase engagement.