Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study

Objectives To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings. Setting A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings. Participants A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres. Outcomes We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no). Results 196 patients (38-96years old, 50.5% women) participated. Mean (SD) time to administer was 48.8 +/- 19.6min. Mean acceptability scores ranged from 3.2 +/- 1.3 in hospital to 4.7 +/- 0.9 in primary care, and mean relevance ranged from 3.5 +/- 1.0 in hospital to 4.9 +/- 0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1 +/- 0.6 and the mean action score was 11.2 +/- 5.6 (of a possible 25). Conclusions The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate.