{
  "abstract": "Aim To assess the socio-demographic and clinical predictors of individuals engaging with Advance Care Planning (ACP) and Advance Care Directives (ACD) using data from the 45 and Up longitudinal cohort study in NSW, Australia.Research Questions What are the socio-demographic factors associated with ACP and ACD completion?What clinical factors influence the likelihood of ACP and ACD completion?Background ACP is crucial for ensuring that individuals’ healthcare preferences are understood and respected when they are unable to make decisions themselves. Understanding the factors that influence engagement with ACP and ACD can help improve participation rates and ensure better healthcare outcomes.Methods We analysed data from 28,626 participants who responded to ACP-related questions in the wave 2 questionnaire (2014–2015) of the Sax Institute’s 45 and Up Study which is an ongoing longitudinal cohort study of around 11% of people aged 45 years and older in NSW. Questions examined whether (i) they had discussed wishes with someone else, (ii) legally nominated a person to make health decisions if they lost capacity, and/or (iii) completed an ACD. Poisson regression modeling was used to estimate the prevalence ratio (PR) and 95% confidence intervals (CI) for various predictors.Results Out of 28,626 participants, 61% engaged in at least one type of ACP and 13.1% completed ACD. Key predictors of ACP and ACD completion included having a will, advancing age, female gender, private health insurance, not currently working, having a university degree, and one or more self-reported medical conditions. Unique predictors for ACP completion included being married/defacto and having a healthcare concession card. Being a carer increased ACD rates, whereas being married or in a defacto relationship decreased ACD completion.Discussion The findings highlight the importance of socio-demographic and clinical factors in influencing ACP engagement. Married/defacto individuals appears to prefer verbal communication with a trusted decision-maker and partner over formal documentation of preferences.Unique Contribution This study provides comprehensive insights into the socio-demographic and clinical factors associated with ACP engagement in a large community cohort. It is one of the few studies to use a large sample to explore these predictors, offering valuable data for future policy and practice improvements.Implications Tailored strategies may promote ACP engagement, particularly among younger individuals, men, and those without private health insurance. An individualised approach to ACP rather than a focus on ACD completion could be effective in engaging individuals with varying relationship statuses.",
  "authors": [
    {
      "affiliations": [
        "University of New South Wales, Sydney, Australia"
      ],
      "name": "Ella Yang"
    },
    {
      "affiliations": [
        "University of New South Wales, Sydney, Australia",
        "The George Institute, Sydney, Australia"
      ],
      "name": "Alamgir Kabir"
    },
    {
      "affiliations": [
        "University of New South Wales, Sydney, Australia"
      ],
      "name": "Joel Rhee"
    },
    {
      "affiliations": [
        "University of New South Wales, Sydney, Australia"
      ],
      "name": "Cathy O’Callaghan"
    },
    {
      "affiliations": [
        "University of New South Wales, Sydney, Australia"
      ],
      "name": "Margo Barr"
    }
  ],
  "title": "26 Socio-demographic and clinical factors affecting advance care planning: large community longitudinal cohort in NSW, Australia",
  "uid": "fc722b31-380a-535c-b7e7-88c5b0673841"
}