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Understanding Advance Care Planning Among Young Adults: A Theory-Based Examination Using the Integrated Behavioral

Colette A McAfee1, Derek Cegelka2, Victoria R Wagner-Greene3

  • 1School of Nursing and Health Sciences, Westminster University, Salt Lake City, Utah, USA.

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|January 6, 2026
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Summary

Young adults often neglect advance care planning (ACP), despite its benefits. Personal experiences with serious illness significantly motivate ACP engagement, suggesting tailored interventions can improve participation.

Keywords:
Advance care planning (ACP)Integrated Behavioral Model (IBM)Precaution Adoption Process Model (PAPM)end-of-life (EOL)young adults

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Area of Science:

  • Public Health
  • Behavioral Science
  • Gerontology

Background:

  • Advance care planning (ACP) allows individuals to document medical wishes for future incapacity.
  • ACP offers benefits like reduced family stress and improved end-of-life care.
  • Young adults are notably underrepresented in ACP processes.

Purpose of the Study:

  • To examine predictors of advance care planning (ACP) behaviors in U.S. adults aged 18-35.
  • To identify key motivators and barriers to ACP engagement in young adults.
  • To apply the Integrated Behavioral Model (IBM) and Precaution Adoption Process Model (PAPM) to ACP behaviors.

Main Methods:

  • Surveyed 614 U.S. adults aged 18-35 on ACP behaviors and psychosocial factors.
  • Defined ACP engagement as completing a living will, designating a durable power of attorney for health care (DPAHC), and discussing wishes.
  • Utilized regression analyses to identify significant predictors of ACP intention and engagement.

Main Results:

  • 68.6% of participants had not fully engaged in ACP.
  • Direct perceived norms, attitudes, and serious illness experiences predicted ACP intention.
  • Younger respondents (18-25) showed stronger IBM construct scores but lower overall engagement.
  • Participants closer to action (PAPM stage 5) reported higher attitudes, norms, self-efficacy, and intention.

Conclusions:

  • Personal or family experiences with life-threatening illness are crucial motivators for ACP.
  • Theory-informed, stage-based interventions can enhance ACP engagement among young adults.
  • Interventions should address social norms, self-efficacy, and knowledge through developmentally appropriate strategies.