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Objectives: This study examines trends in advance care planning (ACP) awareness, engagement, attitude and experiences among the public in British Columbia (BC), Canada, from 2012 to 2020. This time period is of relevance as it includes provincial education initiatives. We also explored demographic characteristics associated with lower ACP awareness and engagement, to inform future initiatives., Methods: Longitudinal data from two provincial polls in 2016 and 2020, along with BC-specific data extracted from a national poll in 2012, were analysed to investigate ACP awareness, engagement and attitudes. Demographic characteristics associated with ACP were examined using binomial and ordinal logistic regression., Results: We observed an increase in awareness of ACP between 2012 and 2020 (from 15.2% to 32.9%). A significant rise in engagement was also observed, with more respondents reporting ACP conversations with healthcare providers between 2016 and 2020 (8.8%-14%) and documenting their healthcare wishes since 2012 (11.6%-28.0%). Demographic analysis revealed that older, female and more educated individuals were more likely to participate in ACP activities., Conclusions: This study highlights positive trends in ACP awareness and engagement in BC over the study period. Despite lower rates in some variables, the observed increases suggest increasing awareness over time, with potential for further improvement. However, disparities persist among different demographic groups, highlighting the need for targeted efforts to improve ACP knowledge and participation, especially among younger adults, males, single individuals and those with lower education levels., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Despite the established benefits of Advance Care Planning (ACP), engagement remains low in British Columbia. Since 2016, a growing number of community-based nonprofits have offered ACP education. To date, no study has focused on the perspectives of nonprofits on ACP in British Columbia., Objective: This study aimed to identify barriers and facilitating actions to ACP as perceived by British Columbian nonprofits., Design: A mixed-methods design was used. Data were collected through online surveys and telephone interviews., Setting and Participants: Staff and volunteers from British Columbian nonprofits that are providing or interested in providing public education on ACP were recruited for this study., Results: The lack of public awareness of ACP, the emotional difficulty of the conversation, the complicated ACP process, the belief that ACP is synonymous with completing a medical order form, the challenge of introducing ACP in different cultural contexts and the siloed approach to ACP education were rated as the most important barriers to ACP engagement. The most important facilitating actions were developing clear messages, improving ACP literacy, reframing ACP as part of life planning, simplifying ACP documentation and transfer, integrating ACP conversations into clinical practice and better collaboration between the health system and nonprofits., Discussion: This study identifies numerous opportunities to improve ACP engagement in British Columbia from a community lens. To maximize ACP engagement, community-led ACP education should be offered in coordination with the health system., Conclusion: Community-led ACP education as well as collaboration and consultation with nonprofits are part of the solution to the low ACP engagement in British Columbia., Public Contribution: Study participants, including staff and volunteers at nonprofits, are members of the public., (© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.)