Background: Advanced care planning (ACP) is important to ensure that individuals have control over, and to improve the quality of, end-of-life care. Our aim was to explore the relationship of ACP and sociodemographic and health system factors, while identifying whether differences exist between nations.

Methods: We analyzed data from the 2021 Commonwealth Fund International Health Policy (IHP) Survey of Older Adults. Respondents were from 11 high-income nations. Our composite outcome comprised three yes/no ACP questions on the IHP. Positive responses were totaled to create a composite variable with values from 0 (no ACP questions positively answered) to 3 (all ACP questions positively answered). We calculated descriptive statistics and used generalized linear mixed modeling to model the predictor variable.

Results: 18,698 respondents were included in the final analyses and the overall rate of ACP was 65.5%. Highest rates of ACP completion were observed in Germany (86.6%), Canada (80.0%), and the United States (80.0%), while lowest rates were observed in Norway (62.6%), Sweden (62.5%), and France (51.1%). ACP was observed to increase with age, education, and income, and was higher among females, those with multiple chronic diseases, and those recently hospitalized.

Conclusion: Our study has found that while the overall rate of ACP was high among these 11 high-income nations, there were significant differences between nations and along some demographic variables. Strategies such as legislation, public awareness campaigns, and making documents like advance directives legally binding could help to improve ACP rates.