Background Many initiatives to promote ACP have been occurring in British Columbia (BC) over the last decade, however the impact of these activities on public awareness and engagement is unclear. To longitudinally investigate ACP awareness and engagement, we conducted polls with the BC public in 2016 and 2020 and and re-interrogated previously published poll from 2012.

Methods 2016 and 2020 polls were conducted with 500 English speaking Adults living in BC by Mustel market research firm in September 2016 and February 2020 respectively. Questions about ACP included Awareness, and engagement in the following activities: Thought about wishes, thought about Substitute Decision Maker (SDM), Documented their ACP, had a discussion with a family member or friend, and had a discussion with a healthcare provider (HCP). The 2012 poll, conducted by Ipsos Reid eNation Canada for CARENET, was re-interrogated for BC data, with overlapping questions about awareness, and conversations with a family member or friend and healthcare provider. All three polls were weighted to be representative of the adult BC population according to age, gender and region. Polls were analysed using binomial logistic regression.

Results Awareness of ACP increased between 2012 and 2016/2020. Discussions with Healthcare Providers increased between 2012/2016 and 2020. Men had approximately half as much awareness and engagement in all ACP activities asked about except documentation and conversation with a HCP. Similarly, awareness and engagement were lower in younger respondents for all activities except documentation and conversation with a HCP. for overall ACP engagement, in addition to age and gender, it was lower for respondents within Metro Vancouver, compared to elsewhere in the province.

Conclusion While awareness of ACP has increased in the time period studied, besides conversations with HCP, engagement has not increased. These results also highlight the need for interventions that particularly target men.