{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T04:08:05Z","timestamp":1774670885788,"version":"3.50.1"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,21]],"date-time":"2024-08-21T00:00:00Z","timestamp":1724198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002141","name":"Public Health England","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002141","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Advance care planning has been advocated as a way for people to have their wishes recorded and respected in relation to types of treatment and place of care. However, uptake in England remains low.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Aims<\/jats:title>\n<jats:p>To examine the views of older, well, adults towards Advance Care Plans (ACPs) and planning for end-of-life care, in order to inform national policy decisions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A mixed methods approach was adopted, involving individual and mini-group qualitative interviews (n = 76, ages 45\u201385), followed by a quantitative survey (n = 2294, age 55+). The quantitative sample was based on quotas in age, gender, region, socio-economic grade, and ethnicity, combined with light weighting to ensure the findings were representative of England.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Knowledge and understanding of advance care planning was low, with only 1% of survey respondents reporting they had completed an ACP for themselves. Common reasons for not putting wishes into writing were not wanting\/needing to think about it now, the unpredictability of the future, trusting family\/friends to make decisions, and financial resources limiting real choice.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Whilst advance care planning is seen as a good idea in theory by older, well, adults living in the community, there is considerable reticence in practice. This raises questions over the current, national policy position in England, on the importance of written ACPs. We propose that policy should instead focus on encouraging ongoing conversations between individuals and all those (potentially) involved in their care, about what is important to them, and on ensuring there are adequate resources in community networks and health and social care systems, to be responsive to changing needs.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0306810","type":"journal-article","created":{"date-parts":[[2024,8,21]],"date-time":"2024-08-21T23:41:19Z","timestamp":1724283679000},"page":"e0306810","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Attitudes towards advance care planning amongst community-based older people in England"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1693-9018","authenticated-orcid":true,"given":"Sara","family":"Spear","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ed","family":"Little","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Tapp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clive","family":"Nancarrow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvette","family":"Morey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6303-4123","authenticated-orcid":true,"given":"Stella","family":"Warren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Verne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,8,21]]},"reference":[{"issue":"2","key":"pone.0306810.ref001","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1468-0009.2010.00596.x","article-title":"The evolution of health care advance planning law and policy","volume":"88","author":"CP Sabatino","year":"2010","journal-title":"Milbank Q"},{"issue":"2","key":"pone.0306810.ref002","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/bjsw\/bct013","article-title":"Advance Care Planning in the USA and UK: A Comparative Analysis of Policy, Implementation and the Social Work Role","volume":"43","author":"GL Stein","year":"2013","journal-title":"The British Journal of Social Work"},{"issue":"2","key":"pone.0306810.ref003","doi-asserted-by":"crossref","first-page":"e0116629","DOI":"10.1371\/journal.pone.0116629","article-title":"Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies.","volume":"10","author":"S Lund","year":"2015","journal-title":"PLoS One."},{"issue":"8","key":"pone.0306810.ref004","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1177\/0269216314526272","article-title":"The effects of advance care planning on end-of-life care: a systematic review.","volume":"28","author":"A Brinkman-Stoppelenburg","year":"2014","journal-title":"Palliative Medicine"},{"issue":"3","key":"pone.0306810.ref005","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1080\/13648470.2017.1285000","article-title":"Living into death: a case for an iterative, fortified and cross-sector approach to advance care planning.","volume":"24","author":"R Llewellyn","year":"2017","journal-title":"Anthropology & Medicine."},{"key":"pone.0306810.ref006","volume-title":"The end-of-life care strategy","author":"Department of Health","year":"2008"},{"key":"pone.0306810.ref007","author":"National Palliative and End-of-life Care Partnership","year":"2021","journal-title":"Ambitions for Palliative and End-of-life Care: A national framework for local action 2021\u20132026"},{"issue":"2","key":"pone.0306810.ref008","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1093\/fampra\/cmy055","article-title":"How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study.","volume":"36","author":"JJ Glaudemans","year":"2019","journal-title":"Family Practice."},{"key":"pone.0306810.ref009","volume-title":"British Social Attitudes.","author":"J Shucksmith","year":"2012"},{"issue":"1","key":"pone.0306810.ref010","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/fampra\/cmu074","article-title":"Advance care planning in primary care, only for severely ill patients? A structured review","volume":"32","author":"JJ Glaudemans","year":"2015","journal-title":"Family Practice."},{"issue":"4","key":"pone.0306810.ref011","doi-asserted-by":"crossref","first-page":"e225088","DOI":"10.1001\/jamanetworkopen.2022.5088","article-title":"Efficacy of a Communication-Priming Intervention on Documented Goals-of-Care Discussions in Hospitalized Patients With Serious Illness: A Randomized Clinical Trial\u2019","volume":"5","author":"RY Lee","year":"2022","journal-title":"JAMA Network Open"},{"issue":"7","key":"pone.0306810.ref012","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1177\/02692163221102266","article-title":"Health care professionals\u2019 perceptions of factors influencing the process of identifying patients for serious illness conversations: A qualitative study.","volume":"36","author":"JS Morberg","year":"2022","journal-title":"Palliative Medicine."},{"issue":"384","key":"pone.0306810.ref013","article-title":"Serious illness care Programme UK: assessing the \u2018face validity\u2019, applicability and relevance of the serious illness conversation guide for use within the UK health care setting.","volume":"19","author":"T McGlinchey","year":"2019","journal-title":"BMC Health Services Research."},{"key":"pone.0306810.ref014","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/ajag.12639","article-title":"Facilitators and barriers to advance care planning implementation in Australian aged care settings: A systematic review and thematic analysis","volume":"38","author":"F Batchelor","year":"2019","journal-title":"Australasian Journal on Ageing"},{"issue":"615","key":"pone.0306810.ref015","doi-asserted-by":"crossref","first-page":"657","DOI":"10.3399\/bjgp13X673667","article-title":"Do the elderly have a voice? Advance care planning discussions with community-based and older individuals: a systematic literature review and narrative synthesis","volume":"63","author":"T Sharp","year":"2013","journal-title":"British Journal of General Practice"},{"key":"pone.0306810.ref016","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1136\/bmjspcare-2012-000327","article-title":"The impact of advance care planning of place of death, a hospice retrospective cohort study","volume":"3","author":"J Abel","year":"2013","journal-title":"BMJ Supportive & Palliative Care."},{"key":"pone.0306810.ref017","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1136\/bmjspcare-2015-000971","article-title":"Advance care planning in England: Is there an association with place of death? Secondary analysis of data from the National Survey of Bereaved People","volume":"9","author":"J Dixon","year":"2019","journal-title":"BMJ Supportive & Palliative Care."},{"issue":"12","key":"pone.0306810.ref018","doi-asserted-by":"crossref","first-page":"e0242914","DOI":"10.1371\/journal.pone.0242914","article-title":"Impact of advance care planning on dying in hospital: Evidence from urgent care records.","volume":"15","author":"M Orlovic","year":"2020","journal-title":"PLoS ONE."},{"issue":"7","key":"pone.0306810.ref019","doi-asserted-by":"crossref","first-page":"e0197552","DOI":"10.1371\/journal.pone.0197552","article-title":"Factors associated with advance directives completion among patients with advance care planning communication in Taipei, Taiwan.","volume":"13","author":"D Chu","year":"2018","journal-title":"PLoS ONE"},{"issue":"6","key":"pone.0306810.ref020","doi-asserted-by":"crossref","first-page":"e0252598","DOI":"10.1371\/journal.pone.0252598","article-title":"\u201cI decide myself\u201d- A qualitative exploration of end-of-life decision making processes of patients and caregivers through Advance Care Planning.","volume":"16","author":"P Lall","year":"2021","journal-title":"PLoS ONE"},{"issue":"3","key":"pone.0306810.ref021","doi-asserted-by":"crossref","first-page":"84","DOI":"10.47102\/annals-acadmedsg.V46N3p84","article-title":"Awareness and Attitudes of Community-Dwelling Individuals in Singapore towards Participating in Advance Care Planning.","volume":"46","author":"QX Ng","year":"2017","journal-title":"Annals Academy of Medicine Singapore."},{"issue":"2","key":"pone.0306810.ref022","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/00003246-200102001-00007","article-title":"Advance care planning: Pitfalls, progress, promise.","volume":"29","author":"T. 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An explorative mixed-method study on patients\u2019 preferences and family physicians\u2019 views in Belgium.","volume":"35","author":"A De Vleminck","year":"2018","journal-title":"Family Practice"},{"issue":"1","key":"pone.0306810.ref024","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/j.1745-7599.2008.00369.x","article-title":"Perspectives of healthy elders on advance care planning","volume":"21","author":"H Malcolmson","year":"2009","journal-title":"Journal of the American Academy of Nurse Practice"},{"issue":"9","key":"pone.0306810.ref025","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1089\/jpm.2012.0555","article-title":"Involvement of the Dutch general population in advance care planning: a cross-sectional survey","volume":"16","author":"NJ Raijmakers","year":"2013","journal-title":"Journal of Palliative Medicine"},{"issue":"1","key":"pone.0306810.ref026","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.amepre.2013.09.008","article-title":"Completion of advance directives among US consumers","volume":"46","author":"JK Rao","year":"2014","journal-title":"American Journal of Preventive Medicine"},{"issue":"3","key":"pone.0306810.ref027","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/bmjspcare-2013-000450","article-title":"Teaching general practitioners and doctors-in-training to discuss advance care planning: Evaluation of a brief multimodality education programme","volume":"4","author":"K Detering","year":"2014","journal-title":"BMJ Supportive & Palliative Care."},{"key":"pone.0306810.ref028","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s12904-015-0068-1","article-title":"The prevalence in the general population of advance directives on euthanasia and discussion of end-of-life wishes: a nationwide survey.","volume":"14","author":"A De Vleminck","year":"2015","journal-title":"BMC Palliative Care"},{"key":"pone.0306810.ref029","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/s12877-018-0872-6","article-title":"The importance of trust-based relations and a holistic approach in advance care planning with people with dementia in primary care: a qualitative study.","volume":"18","author":"B Tilburgs","year":"2018","journal-title":"BMC Geriatrics"},{"issue":"1","key":"pone.0306810.ref030","first-page":"57","article-title":"Planning for the end-of-life: the views of older people about advance care statements","volume":"59","author":"J Seymour","year":"2004","journal-title":"Social Science & Medicine."},{"issue":"20","key":"pone.0306810.ref031","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2190\/OM.65.2.c","article-title":"Barriers to completion of advance care directives among African Americans ages 25\u201384: A cross-generational study.","volume":"65","author":"SK West","year":"2012","journal-title":"Omega"},{"issue":"23\u201324","key":"pone.0306810.ref032","doi-asserted-by":"crossref","first-page":"4276","DOI":"10.1111\/jocn.15049","article-title":"Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review","volume":"28","author":"D Blackwood","year":"2019","journal-title":"Journal of Clinical Nursing"},{"issue":"3","key":"pone.0306810.ref033","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.pec.2011.07.008","article-title":"Advance care planning in terminally ill and frail older persons.","volume":"90","author":"RD Piers","year":"2013","journal-title":"Patient Education and Counselling"},{"issue":"4","key":"pone.0306810.ref034","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1093\/fampra\/cmz089","article-title":"Preventing unwanted situations and gaining trust: a qualitative study of older people and families\u2019 experiences with advance care planning in the daily practice of primary care.","volume":"37","author":"J Glaudemans","year":"2019","journal-title":"Family Practice."},{"issue":"2","key":"pone.0306810.ref035","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1080\/10410236.2014.974128","article-title":"Communication Nonaccommodation in Family Conversations About End-of-Life Health Decisions.","volume":"30","author":"A Scott","year":"2015","journal-title":"Health Communication."},{"issue":"2","key":"pone.0306810.ref036","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1108\/13522750010322089","article-title":"Recognising deductive processes in qualitative research","volume":"3","author":"K. 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