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Given the lack of research on geographic variations in advance care planning (ACP) engagement, this study examined whether there were 1) regional variations in engagement in ACP and 2) racial and ethnic differences in ACP by regions of the United States. The sample included 2,015 Medicare beneficiaries in the U.S. from the 2012 National Health and Aging Trends Study that asked respondents about ACP engagement (i.e., discussed end-of-life treatments, had a durable power of attorney for health care, or completed a living will). Results from logistic regression analysis showed that older adults living in the West (OR = 1.66, p =.003) and the Midwest (OR = 1.39, p =.032) were more likely to engage in ACP than those living in the South. Furthermore, logistic regression analyses that examined racial and ethnic differences by region revealed that Blacks were less likely to be engaged in ACP than Whites in the Northeast, Midwest, and South. Hispanics were less likely to participate in ACP than Whites in the West and the Northeast. The findings provide an insight into disparities in ACP in different regions in the U.S., suggesting target areas for interventions to improve engagement in ACP among non-dominant racial and ethnic populations. [ABSTRACT FROM AUTHOR]

(1) Background: Advance directives (ADs) in Portugal have been legalized since 2012. What has been observed over time, from the few studies carried out, is that despite the positive attitudes in the population, there is a low level of adherence to ADs. To try to understand the reasons for these data, the current study aimed to explore and describe the experiences of the Portuguese population regarding AD. (2) Methods: For this exploratory and descriptive qualitative study, the researchers conducted open (unstructured) interviews with a convenience sample aged over 18 years until data saturation was achieved. (3) Results: A total of fifteen interviews were conducted—eight with women and seven with men. The following four categories emerged from the content analysis of the interviews: (1) AD literacy, (2) AD relevance, (3) AD attitudes, and (4) conditionalities for compiling the ADs. (4) Conclusions: The study pointed out the good receptivity of the participants to the ADs; however, literacy on this subject was low, and identifying the conditionalities in the development of ADs could contribute to improvements in implementation in the population. The data from this study suggest the need to implement measures to increase the literacy of the Portuguese population on ADs and review the legal framework for improving the accessibility of the citizen population. There is also a need to continue researching and obtain more evidence about the ways in which the Portuguese population perceives ADs; thus, in this way, a society can better respond to its citizens' right to freely exercise their prospective autonomy at the end of their lives. [ABSTRACT FROM AUTHOR]