Table 3.
Barriers and facilitators for formal advance care planning among midlife and older adults.
| Unadjusted | Adjusted (Adj. R2 = 0.24) | |||||
|---|---|---|---|---|---|---|
| uOR | p | 95%CI | aOR | p | 95%CI | |
| Individual factors | ||||||
| Confidence in ACP | 1.99* | <0.001 | 1.60, 2.48 | 1.80* | <0.001 | 1.49, 2.18 |
| Worry about health | 1.00 | 0.968 | 0.86, 1.16 | 0.63 | 0.051 | 0.40, 1.00 |
| Self-rated health | 1.05 | 0.564 | 0.89, 1.24 | 0.91 | 0.439 | 0.72, 1.15 |
| Push away thoughts about death | 0.67* | 0.021 | 0.48, 0.94 | 0.94 | 0.757 | 0.63, 1.39 |
| Life threatening illness - self | 1.80* | 0.018 | 1.11, 2.91 | 1.19 | 0.531 | 0.69, 2.05 |
| Medical occupation - self | 1.00 | 0.995 | 0.57, 1.74 | 1.05 | 0.872 | 0.58, 1.92 |
| ACP motivation - Religious or spiritual reasons | 1.65* | 0.008 | 1.14, 2.38 | 1.25 | 0.365 | 0.77, 2.03 |
| ACP motivation - Reduce suffering at EOL | 1.84* | <0.001 | 1.34, 2.51 | 1.32 | 0.174 | 0.88, 1.99 |
| ACP motivation - EOL care concordant with preferences | 2.28* | <0.001 | 1.64, 3.18 | 1.28 | 0.234 | 0.85, 1.92 |
| Interpersonal factors | ||||||
| Satisfied with personal relationships | 1.14 | 0.077 | 0.99, 1.33 | 1.14 | 0.544 | 0.75, 1.73 |
| Other persons’ discomfort impedes ACP conversations | 0.73 | 0.133 | 0.49, 1.10 | 1.04 | 0.861 | 0.67, 1.62 |
| Life threatening illness - Family member | 1.24 | 0.199 | 0.89, 1.71 | 0.79 | 0.222 | 0.53, 1.16 |
| Medical occupation - family | 1.60* | 0.008 | 1.13, 2.26 | 1.30 | 0.217 | 0.86, 1.96 |
| Designated as health care decision-maker for someone else | 6.92* | <0.001 | 4.85, 9.86 | 5.31* | <0.001 | 3.50, 8.06 |
| Served as medical decision maker for someone else | 1.70* | 0.001 | 1.24, 2.35 | 1.03 | 0.877 | 0.69, 1.55 |
| One or more EOL stories in personal network | 1.77* | <0.001 | 1.30, 2.42 | 1.31 | 0.148 | 0.91, 1.88 |
| ACP motivation - Ease EOL decision making for others | 2.54* | <0.001 | 1.60, 4.02 | 1.48 | 0.144 | 0.87, 2.51 |
| ACP motivation - Reduce financial costs at EOL | 1.85* | <0.001 | 1.35, 2.53 | 1.23 | 0.332 | 0.81, 1.88 |
| Health care factors | ||||||
| Provider brought up ACP | 3.24* | <0.001 | 2.31, 4.55 | 1.98* | 0.006 | 1.22, 3.22 |
| Usual source of care - Provider’s office/clinic | 2.33* | 0.003 | 1.34, 4.07 | 2.07* | 0.033 | 1.06, 4.04 |
*
p < .05. Models controlled for race/ethnicity, gender, age group, marital status, employment status, and educational attainment. Adjusted R2 is McFadden’s Adjusted R2.