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The balancing point: understanding uptake of advance directive forms in a rural Australian community
  1. Craig Sinclair1,
  2. Kirsten Anne Auret1 and
  3. Ashlee Burgess2
  1. 1Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
  2. 2Rural Clinical School of Western Australia, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Craig Sinclair, Rural Clinical School of Western Australia, University of Western Australia, 31 Stirling Tce, Albany, WA, 6330, Australia;craig.sinclair{at}


Objectives The study was conducted in Western Australia, focusing on the attitudes of older, rural, non-hospitalised people towards newly legislated advance care planning (ACP) documents. This study explored baseline awareness and perception of advance directive (AD) forms and factors relevant to their utilisation, using the transtheoretical model as a theoretical framework.

Methods Sixty-two adults were recruited from residential aged care facilities, community care organisations, general practice, an oncology service and a law firm. Semi-structured interviews were undertaken. These were transcribed and thematically analysed by the authors.

Results Participants gave responses that were consistent with different stages of the transtheoretical model. Perceived susceptibility to the negative consequences of not engaging in AD form utilisation was a trigger for further contemplation. The presence of adequate personal empowerment was important for successful completion of AD forms. There was also qualitative evidence of a negative relationship between perceived susceptibility and empowerment regarding AD form utilisation.

Conclusions Promoting balance between a person's perceived susceptibility and empowerment may be an effective method of increasing engagement with AD forms.

  • advance care planning
  • perceived susceptibility
  • transtheoretical
  • advance directive
  • empowerment

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