Engagement and attitudes towards advanced care planning in primary care during COVID-19: A cross-sectional survey of older adults

Advance care plans (ACPs) increase patient-centered care, reduce caregiver burden and healthcare costs. However, only about 25% of Canadians over 50 years of age have completed an ACP. An anonymous, cross-sectional survey was distributed to those >= 70 years attending a primary care clinic-based COVID-19 vaccination event in Regina, SK in April 2021. The survey included questions about demographics, attitudes, engagement in ACPs according to the Stage of Change model, and patient-reported influence of COVID-19 on ACP thoughts or actions. One hundred thirty-four surveys were completed (96% response rate). Twenty-seven percent of respondents were at the precontemplation stage, 21% at contemplation stage, 16% at planning stage, 26% at action stage, and 10% at maintenance stage. Thirty-three percent of respondents had thought more about ACPs during the pandemic, but few updated or created plans. Most respondents felt comfortable talking with their physician and partners. There is a need for physicians to initiate ACP conversations with patients.