Patient Acceptance of Advance Care Planning Guidebook Distribution at Hospital Admission

Dear Editor:

Clinicians who wish to engage their patients in advance care planning (ACP) encounter numerous barriers, including lack of time and of patient preparedness. ¹ One approach to overcome these barriers is the distribution of printed ACP information.

Our health service has developed ACP informational materials for the public, including a printed guidebook called Conversations Matter. ² At present this is not routinely given to all hospitalized patients; we aimed to determine whether patients felt it was acceptable to receive it at hospital admission.

In 2015 we surveyed 100 English-speaking, cognitively intact patients from two medical inpatient units at our acute care hospital. Patients on these units are of varied ages and have a broad range of diagnoses and prognoses; our sample included patients ranging in age from 22 to 98 years, 40% of whom were female. During the study every patient received a copy of the guidebook as a routine part of the admission process. Once a patient had read the guidebook (or had it read to them by an investigator, if they preferred), we obtained informed consent and then verbally conducted the survey. The multiple choice questions and response choices are listed in Table 1, along with the results. We also recorded responses to several open-ended questions, as well as any spontaneous comments made by each participant. We used descriptive statistics to analyze the data. A Pearson's chi-square test found no differences in responses due to age or gender.

Almost all patients (91%) found the guidebook at least somewhat helpful, and the majority (88%) stated that they did not find it upsetting. Most (86%) were in favor of routine guidebook distribution to patients upon admission to hospital. Qualitative responses to the survey questions suggested that nearly one-quarter of the sample felt ACP is important and the guidebook should be given to everyone. Seventeen participants speculated the guidebook might be upsetting to others (though only 2% were upset by it themselves), but an equal number commented that people should not be upset about discussing ACP, which is “just part of life.” A sizeable minority commented that guidebook distribution should be targeted, either to those closest to end of life, or to those most likely to read and use the materials. Some participants thought ACP is most appropriate for those who are elderly or dying, but our results suggest that receipt of ACP information is acceptable to adult patients of all ages.

The consistency of our results with similar studies in the United Kingdom³ and the United States ⁴ suggests a variety of printed ACP materials are acceptable, at least across English-speaking populations. We did not attempt to evaluate the efficacy of the guidebook in promoting ACP participation. However, others have found distribution of printed materials to be effective.^3,4

Our findings suggest that there is little basis for the fear of upsetting people by providing ACP information during hospitalization; the finding scan reassure health care providers and administrators that it is acceptable to routinely distribute ACP information.