Characteristics of respondents who did or did not have an ACP conversation after implementation of ACP
| No ACP (n=308)* | ACP (n=150)* | OR (95% CI) Unadjusted (bivariate) | OR (95% CI) Model† | |
| Age, mean (SD) | 80.2 (4.3) | 82.3 (5.5) | 1.09 (1.05 to 1.14) | 1.10 (1.04 to 1.16) |
| Sex, female | 190 (63.1) | 96 (64.8) | 1.08 (0.72 to 1.63) | |
| Country of birth, NL | 284 (92.2) | 145 (96.7) | 2.45 (0.92 to 6.56) | |
| Marital status, married | 134 (44.7) | 50 (33.8) | 0.63 (0.42 to 0.95) | |
| Level of education | ||||
| Lower secondary education or lower | 160 (52.0) | 79 (52.7) | Reference | |
| Higher secondary education | 68 (22.1) | 35 (23.3) | 1.04 (0.64 to 1.70) | |
| Tertiary education | 80 (26.0) | 36 (24.0) | 0.91 (0.57 to 1.46) | |
| Religious affiliation | ||||
| No specific religious affiliation or atheist | 168 (54.6) | 88 (58.7) | Reference | |
| Protestant | 63 (20.5) | 29 (19.3) | 0.88 (0.53 to 1.46) | |
| Catholic | 42 (13.6) | 15 (10.0) | 0.68 (0.36 to 1.30) | |
| Other | 15 (4.9) | 6 (4.0) | 0.76 (0.29 to 2.04) | |
| Do not want to answer this question | 20 (6.5) | 12 (8.0) | 1.15 (0.54 to 2.45) | |
| Diagnosis (more than one answer possible) | ||||
| Cancer | 17 (5.7) | 14 (9.7) | 1.77 (0.85 to 3.71) | |
| Rheumatism/arthrosis | 84 (28.3) | 42 (29.2) | 1.04 (0.67 to 1.62) | |
| COPD | 32 (10.8) | 12 (8.3) | 0.75 (0.38 to 1.51) | |
| Diabetes | 39 (13.1) | 18 (12.5) | 0.95 (0.52 to 1.72) | |
| Heart condition | 79 (26.6) | 36 (25.0) | 0.92 (0.58 to 1.45) | |
| Stroke/cerebrovascular accident | 13 (4.4) | 14 (9.7) | 2.35 (1.08 to 5.15) | 2.51 (0.92 to 6.83) |
| Dementia | 4 (1.4) | 3 (2.1) | 1.56 (0.34 to 7.06) | |
| Depression | 16 (5.4) | 5 (3.5) | 0.63 (0.23 to 1.76) | |
| Multiple sclerosis | 0 | 0 | ||
| Amyotrophic lateral sclerosis | 0 | 0 | ||
| Other | 63 (21.2) | 38 (26.4) | 1.33 (0.84 to 2.12) | |
| None | 83 (28.0) | 27 (18.8) | 0.59 (0.36 to 0.97) | |
| Do you have a clear idea about future health problems that you might face? | ||||
| Don’t know/no | 197 (65.0) | 80 (54.4) | Reference | Reference |
| Yes | 106 (35.0) | 67 (45.6) | 1.56 (1.04 to 2.33) | 1.25 (0.75 to 2.11) |
| Preferred timing of ACP, never (vs ever) | 17 (6.1) | 1 (0.8) | 0.12 (0.02 to 0.93) | |
| If ever, preferred timing is | ||||
| Before someone is ill | 46 (17.6) | 43 (34.1) | Reference | Reference |
| At time of diagnosis of a possible life-threatening illness | 90 (34.5) | 39 (31.0) | 0.46 (0.26 to 0.81) | 0.63 (0.32 to 1.22) |
| When it is clear that it is no longer possible to cure from the illness | 125 (47.9) | 44 (34.9) | 0.38 (0.22 to 0.65) | 0.52 (0.28 to 0.99) |
| Having had an ACP conversation at first measurement (before implementation), yes | 38 (12.3) | 63 (42.0) | 5.15 (3.22 to 8.23) | 3.85 (2.07 to 7.15) |
| Reasons not to engage in ACP | ||||
| My next of kin know what I want | 114 (37.0) | 61 (40.7) | 1.17 (0.78 to 1.74) | |
| I see no reason not to talk about it | 127 (41.2) | 59 (39.3) | 0.92 (0.62 to 1.38) | |
| I don’t want to think about the future or about getting (more) ill | 49 (15.9) | 11 (7.3) | 0.42 (0.21 to 0.83) | |
| My GP knows what I want | 12 (3.9) | 28 (18.7) | 5.67 (2.79 to 11.50) | 3.27 (1.17 to 9.12) |
| I am healthy, there is no reason to do so | 10 (3.3) | 1 (0.7) | 0.20 (0.03 to 1.58) | |
| I am afraid I don’t get the opportunity to change preferences later | 3 (1.0) | 1 (0.7) | 0.68 (0.07 to 6.62) | |
| I don’t know what the future will bring | 8 (2.6) | 1 (0.7) | 0.25 (0.03 to 2.03) | |
| Other reasons | 7 (2.3) | 6 (4.0) | 1.79 (0.59 to 5.43) |
Bold indicates a p-value < 0.05.
*Characteristics at pre-measurement are reported, if missing in pre-measurement then answer at post-measurement was used in country of birth, education and religion. Missing data: age no ACP n=9, ACP n=4; sex no ACP n=7, ACP n=2; marital status no ACP n=8, ACP n=2; diagnosis no ACP n=11, ACP n=6; idea about future health problems no ACP n=5, ACP n=3; preferred timing no ACP n=30, ACP n=23; reasons not to engage in ACP: missing answers were coded as ‘no’.
†Backward logistic multilevel regression procedure (to adjust for organisation), model with random intercept is reported, removal at p>0.10.
ACP, advance care planning; COPD, chronic obstructive pulmonary disease; GP, general practitioner; NL, the Netherlands.