Patient Activation: A Key Component of Successful Advance Care Planning

Daniel David, Deborah E. Barnes, Ryan D. McMahan, Ying Shi, Mary T. Katen, Rebecca L. Sudore

Research output: Contribution to journalArticle

Abstract

Background: Patient activation - or knowledge, confidence, and skill managing overall health - is associated with improved health behaviors such as exercise; it is unknown whether it is associated with advance care planning (ACP). Objective: To determine whether patient activation is associated with ACP. Design: This is a cross-sectional study. Setting/Subjects: A total of 414 veterans (≥60 years) with serious and chronic illness enrolled in an ACP trial. Measures: Patient characteristics and self-report surveys included the validated 13-item patient activation measure (PAM, five-point Likert) (e.g., "Taking an active role in your own healthcare is the most important factor⋯") categorized into four levels (e.g., Level 1: "disengaged and overwhelmed" to Level 4: "maintaining behaviors"). ACP was measured with the ACP Engagement Survey including 57-item process scores (i.e., knowledge, contemplation, self-efficacy, readiness, 5-point Likert scale) and 25-item action scores (i.e., surrogate designation, yes/no items). Associations were determined with linear regression. Results: Participants were 71.1 ± 7.8 years of age, 43% were non-white, 9% were women, and 20% had limited health literacy. Higher PAM levels were associated with higher finances, having adult children, lower comorbidity, and more social support (p < 0.05). After adjusting for these characteristics, higher PAM (Level 4 vs. Level 1) was associated with higher ACP engagement (ACP process scores, 2.8 ± 0.7 vs. 3.8 ± 0.7 and action scores 9.7 ± 4.4 vs. 15.1 ± 6.0, p < 0.001). Conclusions: Higher patient activation to manage one's overall healthcare is associated with higher engagement in ACP. Interventions designed to foster general patient activation and self-efficacy to engage in health behaviors and disease management may also improve engagement in the ACP process.

Original languageEnglish (US)
Pages (from-to)1778-1782
Number of pages5
JournalJournal of palliative medicine
Volume21
Issue number12
DOIs
StatePublished - Dec 2018

Keywords

  • advance care planning
  • older adults
  • patient activation
  • patient engagement

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Fingerprint Dive into the research topics of 'Patient Activation: A Key Component of Successful Advance Care Planning'. Together they form a unique fingerprint.

  • Cite this

    David, D., Barnes, D. E., McMahan, R. D., Shi, Y., Katen, M. T., & Sudore, R. L. (2018). Patient Activation: A Key Component of Successful Advance Care Planning. Journal of palliative medicine, 21(12), 1778-1782. https://doi.org/10.1089/jpm.2018.0096