P026 Efficacy of Speak Up Tools to Improve Patient Engagement in Advance Care Planning

Advance care planning (ACP) can improve satisfaction with end-of-life care and reduce unwanted treatments. The longstanding relationship between patients, their families and family physicians makes primary care ideal for starting ACP conversations. However, physicians lack of time and resources as barriers to ACP; hence, self-completed ACP tools are a way to initiate patient ACP. Speak Up offers Pan-Canadian ACP tools that are publically available in both official languages, as well as in paper- and web-based formats. To evaluate the efficacy of Speak Up tools (Ontario and National workbooks; British Columbia and National websites) to improve ACP engagement in adult primary care patients across Canada. This multicenter, prospective study used a 55-item version of a validated ACP engagement survey (ACP-55) (with 5-point Likert scales reflecting behaviour change domains) pre- and post-intervention to evaluate changes in ACP engagement among Speak-Up tool users. Consecutive eligible patients, 50 and older, English-speaking and cognitive, completed an ACP-55 survey before and after completing one of the Speak Up tools. Participants (n=39) were 65+9.6 years; 71.8% women; 74.4% married/common-law; 97.4% English-speaking. Participant behaviour change process measures (ACP knowledge, contemplation, self-efficacy and readiness) increased after using Speak Up tools. Readiness to choose a substitute decision-maker (SDM) increased from 3.49 (pre) to 3.97 (post) (ns). Readiness to talk to their doctor about their choice of SDM increased from 2.21 (pre) to 2.97 (post) (p=.001). Readiness to sign official papers naming an SDM increased from 2.90 (pre) to 3.44 (post) (p=.000). Readiness to talk to their SDM about health conditions that would make life not worth living rose from 3.33 (pre) to 3.95 (post) (p=.000). Our preliminary findings demonstrate that Speak Up resources are effective tools to improve ACP engagement among patients in primary care.