Article Text

Download PDFPDF
Advance care planning in British Columbia: awareness and engagement (2012–2020)
  1. Rachel Zoe Carter1,2,
  2. Eman Hassan1,2 and
  3. Doris Barwich1,2
  1. 1Division of Palliative Care, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2British Columbia Centre for Palliative Care, New Westminster, British Columbia, Canada
  1. Correspondence to Dr Rachel Zoe Carter, Division of Palliative Care, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; rcarter{at}


Objectives This study examines trends in advance care planning (ACP) awareness, engagement, attitude and experiences among the public in British Columbia (BC), Canada, from 2012 to 2020. This time period is of relevance as it includes provincial education initiatives. We also explored demographic characteristics associated with lower ACP awareness and engagement, to inform future initiatives.

Methods Longitudinal data from two provincial polls in 2016 and 2020, along with BC-specific data extracted from a national poll in 2012, were analysed to investigate ACP awareness, engagement and attitudes. Demographic characteristics associated with ACP were examined using binomial and ordinal logistic regression.

Results We observed an increase in awareness of ACP between 2012 and 2020 (from 15.2% to 32.9%). A significant rise in engagement was also observed, with more respondents reporting ACP conversations with healthcare providers between 2016 and 2020 (8.8%–14%) and documenting their healthcare wishes since 2012 (11.6%–28.0%). Demographic analysis revealed that older, female and more educated individuals were more likely to participate in ACP activities.

Conclusions This study highlights positive trends in ACP awareness and engagement in BC over the study period. Despite lower rates in some variables, the observed increases suggest increasing awareness over time, with potential for further improvement. However, disparities persist among different demographic groups, highlighting the need for targeted efforts to improve ACP knowledge and participation, especially among younger adults, males, single individuals and those with lower education levels.

  • Advance Care Planning
  • Advance Directives

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.


  • Contributors RZC: formal analysis, writing–original draft. EH: conceptualisation, methodology, writing–review and editing, guarantor. DB: supervision, funding acquisition, writing–review and editing.

  • Funding This work was funded by the BC Centre for Palliative Care through a grant from the British Columbia Ministry of Health.

  • Disclaimer The views expressed by the authors of this paper do not necessarily represent the views of the government funding source.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.