Evaluation of a Community-Based Advance Care Planning Campaign for a General Adult Population

Early advance care planning (ACP) has been widely recommended, but overall uptake remains low. Most efforts to improve formal ACP adoption, namely living will (LW) and health care agent (HCA) documentation, focus on medical settings targeted at older adults with serious or chronic illness, while community-based ACP campaigns are limited.

Describe the development and implementation of a community-based campaign (2017-2021) aimed at increasing ACP adoption and evaluating its outcomes at both the community level and across subgroups by race, ethnicity, and age.

Howard County, Maryland, United States.

Nonexperimental study design.

A mixed-mode, representative survey of 2000+ county residents was conducted biennially between 2016 and 2021 (one survey was delayed due to COVID-19). Main outcome measures were self-attestation to completing LW and HCA documentation.

In total, 6037 respondents over three years completed the survey. χ² analysis showed that the prevalence of ACP adoption increased overall by over 10% (p < 0.001) since 2016. While upward trends in ACP adoption were observed across all racial groups, statistically significant increases were found among only White and Hispanic residents (p < 0.001). Logistic regression analysis found that increased odds of ACP adoption were associated with the community campaign for residents ≤65 years of age, White residents, married individuals, and those with a regular health care provider after controlling for confounding factors (e.g., odds ratios = 1.35, p < 0.001).

Community-based ACP campaigns can result in increased ACP awareness and adoption in the general adult population, though more work is needed to encourage ACP adoption in diverse communities.