Background Individuals’ attitudes toward advance care planning (ACP) can be influenced by their health literacy and knowledge of the topic. Health literacy skills influence how people perceive their health difficulties, communicate with healthcare providers, and make medical decisions. Knowledge regarding end-of-life medical situations is likely to shape individuals’ decisions to engage in ACP. This study investigates the associations between individuals’ health literacy and knowledge of ACP and their attitudes toward end-of-life care planning among a representative sample of adults aged 58+ in Switzerland.
Method We used data from 1,369 respondents from wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe. Subjective ACP health literacy was measured with questions on the competencies in understanding medical interventions, finding information, communicating, and making decisions about end-of-life care options. Respondents’ knowledge was assessed using test-based questions on 11 end-of-life medical situations. Engagement in end-of-life care planning was measured by having advance directives (ADs) and/or having designated a healthcare proxy and approving to have ADs in the future. Associations were estimated using separate probit regressions, controlling for social, health, and regional characteristics.
Results We found that respondents with higher ACP health literacy tended to have higher end-of-life knowledge. Individuals with higher ACP health literacy were also more likely to approve and have ADs. Individuals with higher knowledge scores were more likely to have completed ADs. Finally, when we simultaneously included both variables in the model, only the positive association of ACP health literacy with approval and completion of ADs remained statistically significant.
Conclusions Our findings show that ACP health literacy seems to play a preponderant role in ADs approval and completion. Thus, encouraging the writing of ADs should not be based exclusively on informing individuals but should focus on strengthening their competencies to complete ADs by providing them with adequate support.
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