Unmarried patients with early cognitive impairment are more likely than their married counterparts to complete advance care plans

Abstract

As unmarried patients may not have immediate family members to depend on to make decisions, they may perceive ACP to be more important and relevant. Understanding the barriers to ACP completion can facilitate targeted interventions to improve the uptake of ACP.

Perspectives and Experiences of Persons With Dementia With Advance Care Planning: An Integrative Literature Review

“…Being older, white, and married, and having college education were significant correlates of advance directive completion. Lo et al 34 Being single was the only predictor of advance directive completion.…”

“…31,34 Of 13 observational studies, only 5 used longitudinal designs. 3,28,31,34,39 Of 5 intervention studies, one used a randomized controlled design. 30 The studies were done in the United States (n ¼ 6), United Kingdom (n ¼ 5), Singapore (n ¼ 2), Australia (n ¼ 2), the Netherlands (n ¼ 1), Israel (n ¼ 1), and Ireland (n ¼ 1).…”

“…After completing the advance directive documentation, an unreported number of participants reported the experience to be positive. Lo et al 34 After attending an educational session about ACP, 77 (49%) patients were keen on further ACP conversation, and 81 (51%) patients were not. Of those 49% (n ¼ 77) who were keen on further ACP session, 22% completed the advance directive.…”

“…Lingler et al 33 reported that being older, white, and college educated were associated with AD completion whereas Garand et al 39 reported that being younger (less than 65 years old) was associated with a higher likelihood of completing an AD if participants were male, married, had more severe cognitive impairment, had a family member with Alzheimer's disease, or did not have depression at the start of the study. Lo et al 34 found that the only significant correlate of ACP engagement was having never been married. Tay et al 38 reported that PWDs' not thinking about ACP was the most commonly cited barrier to ACP; other barriers were passive coping, measured as having no immediate plan in one's day-to-day life to participate in ACP, and a reliance on family to make future decisions.…”

“…This domain included 5 studies that developed and/or tested an intervention that either aimed to increase ACP participation by PWDs or included ACP as a part of the intervention to improve quality of life (QOL) of PWDs. Four studies tested ACP interventions for PWDs to increase ACP engagement, 25,32,34,40 and an additional study tested an intervention intended to improve health outcomes. 39 Sample sizes ranged across these studies from as few as 19 participants 30 to 158.…”