Article Text

other Versions

Download PDFPDF
Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013
  1. J E Simon1,2,
  2. S Ghosh3,4,
  3. D Heyland5,6,
  4. T Cooke7,
  5. S Davison8,
  6. J Holroyd-Leduc2,
  7. E Wasylenko1,9,
  8. J Howlett10 and
  9. K Fassbender11,12
  10. for the Advance Care Planning Collaborative Research and Innovation Opportunities Program (ACP CRIO)
  1. 1Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Medical Oncology, Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
  4. 4Alberta Health Services-Cancer Control
  5. 5Clinical Evaluation Research Unit, Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada
  6. 6Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
  7. 7Health Quality Council of Alberta, Calgary, Alberta, Canada
  8. 8Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
  9. 9John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada.
  10. 10Department of Cardiac Sciences, University of Calgary, and Libin Cardiovascular Institute, Calgary, Alberta, Canada
  11. 11Covenant Health Palliative Institute, Edmonton, Alberta, Canada
  12. 12Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr JE Simon, Division of Palliative Medicine, Department of Oncology, 1403 29 St NW, University of Calgary, Calgary, AB, Canada T2N 2T9; Jessica.simon{at}


Background Advance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.

Methods Raw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.

Results Statistically significant increases were observed between 2007 and 2013 in: recognising the definition of ACP (54.8% to 80.3%, OR 3.37 (95% CI 2.68 to 4.24)), discussions about healthcare preferences with family (48.4% to 59.8%, OR 1.41 (95% CI 1.17 to 1.69)) and with healthcare providers (9.1% to 17.4%, OR 1.98 (95% CI 1.51 to 2.59)), written ACP plans (21% to 34.6%, OR 1.77 (95% CI 1.45 to 2.17)) and legal documentation (23.4% to 42.7%, OR 2.13 (95% CI 1.75 to 2.59)). These remained significant after adjusting for age, education and self-rated health status.

Conclusions ACP engagement increased over time, although the overall frequency remains low in certain elements such as discussing ACP with healthcare providers. We discuss factors that may be responsible for the increase and provide suggestions for healthcare systems or other public bodies seeking to stimulate engagement in ACP.

  • Communication
  • Service evaluation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.