Family relationships and advance care planning: do supportive and critical relations encourage or hinder planning?

OBJECTIVES The effectiveness of advance care planning (ACP) may depend on family members' understanding of patient preferences. However, we know of no studies that explore the association between family relationship dynamics and ACP. ACP includes a living will, durable power of attorney for health care (DPAHC) appointment, and discussions. We evaluated the effects of three aspects of family relations--general family functioning, support and criticism from spouse, and support and criticism from children--on both overall ACP and specific DPAHC designations. METHOD Using multinomial logistic regression models and data from a sample of 293 older adults, we estimated the effects of family relationship quality on the likelihood of completing ACP and appointing a spouse or adult child as DPAHC. Analyses controlled for demographic and health characteristics. RESULTS Better overall family functioning increased the odds of ACP. Higher levels of spousal support increased the odds of holding informal discussions, whereas spousal criticism reduced the odds of naming one's spouse as DPAHC. Both criticism and emotional support from children increased the odds that a child was named as DPAHC. DISCUSSION Family dynamics affect ACP in complex ways and should be considered when patients and their families discuss end-of-life care and make DPAHC designations.