Use of advance directives by South Australians: results from the Health Omnibus Survey Spring 2012

Objective: To determine the prevalence of completion of advance directives (ADs) and wills by South Australians aged 15 years and over. Design, setting and participants: Statewide population-based survey of a single member (aged 15 years and over) of 3055 South Australian households between 4 September and 12 December 2012. Main outcome measures: Prevalence and sociodemographic determinants of completion of the four recognised legal ADs in South Australia (enduring power of attorney [EPA] for finance, enduring power of guardianship [EPG] for health care/lifestyle, medical power of attorney [MPA] for medical treatment and anticipatory direction for end-of-life care) and wills. Results: Nearly half the 3055 survey participants had not completed any AD document or will. Financial documents were more likely to be completed than health care documents. In multivariate analysis, the odds of not having completed any AD was higher among those aged 15-24 years compared with those aged over 65 years (odds ratio [OR], 55.3; 95% CI, 31.3-97.7) and 25-44 years (OR, 24.9; 95% CI, 17.3-36.1). Similarly, the odds were higher for those born in another country (OR, 2.0; 95% CI, 1.6-2.4); those never married (OR, 3.1; 95% CI, 2.3-4.2) or in de facto relationships (OR, 1.8; 85% CI, 1.3-2.4) or separated/divorced (OR, 2.8; 95% CI, 2.1-3.8) compared with those married; those who left school in Year 12 or before (OR, 1.5; 95% CI, 1.1-1.9) or with a bachelor degree (OR, 1.5; 95% CI, 1.1-2.0) compared with those who had completed a trade/apprenticeship, certificate/diploma; and those in blue collar occupations (OR 1.6; 95% CI, 1.3-2.2) or not employed (OR, 2.2; 95% CI, 1.4-3.6) versus professionals. The odds of not having completed any AD were lower for those living in rural or regional areas (OR, 0.8,95% CI, 0.6-1.0) compared with the metropolitan area, and for those in the highest income bracket earning more than $80000 (OR, 0.6; 95% CI, 0.5-0.8) compared with those in the middle bracket earning $40 000-$80 000. Conclusion: Completion rates of ADs among South Australians remain low, with financial instruments more likely to be completed than health care and lifestyle instruments. The odds of not completing ADs were associated with age and socioeconomic characteristics. General practitioners are in a good position to target advance care planning towards relevant patient groups, which would likely improve rates of decision making in future health care.