Advance care planning (ACP) is an important tool for preserving patient autonomy and benefits patients, families, and providers. ACP is underutilized throughout the United States, yet the factors contributing to this deficit are poorly understood. The purpose of this study was to develop an understanding of older individuals’ attitudes towards advance care planning and to characterize perceived barriers to ACP completion.

A sample of 240 United States residents age 65-years and older were invited to complete a survey assessing their attitudes toward ACP through an online panel. Participants were administered a structured questionnaire comprised of scaled items that were derived from prior qualitative discussions about ACP with groups of seniors. An analysis of Likert scale responses was performed to identify common barriers underlying participants’ reluctance to complete advance care plans.

One hundred and thirty (54%) respondents reported having completed an advance care plan, while 110 (46%) had not. Those who completed ACPs feel it is important to avoid burdening their families with difficult decisions and healthcare expenses by stating their preferences, a finding that is consistent with prior research. Among those without advance care plans, 53 (48%) reported they had heard of advance care planning before participating in the study. The most prevalent barriers were uncertainty about healthcare preferences and uncertainty about how to initiate advance care planning. External barriers such as inconvenience, time, and cost did not emerge as important barriers. Free-text responses provided additional context to respondents’ answers.

The relatively low rates of advance care plan completion and awareness among older Americans illustrate a pressing need to expand ACP education. Additionally, participants’ responses indicate that a set of internal barriers inhibit older individuals from completing advance care plans. Understanding these barriers can guide patient-centered discussions of advance care planning across multiple clinical settings and inform community efforts to improve ACP access. In particular, helping patients formulate and articulate their healthcare preferences may help increase ACP uptake.