INTRODUCTION
fits, chronic, life-limiting illness
Patients with chronic, life-limiting illness often still receive medical care that does not align with their values and preferences.Evidence from the literature about which personal characteristics are associated with ACP engagement has mainly focused on whether ACP actions are performed. Increasing age has been found not only to be associated with increased likelihood of having ACP documentationIn comparison, studies that examine ACP as a behaviour change process, instead of discrete actions as described above, are fewer. Behaviour change theory and social cognitive theory have been used to describe processes underlying ACP engagement, including self-efficacy (that is, how confident the patient feels to complete the behaviour) and readiness (that is, the patient’s stage of behaviour change).How this fits inAs ACP is a process of communication, factors pertaining to how GPs, who play a pivotal role in initiating ACP because of their accessibility and continuity of care,Examining the impact of these factors on behaviour change processes for ACP can shed light on which determinants play a role in ACP behaviour change. This information can be taken into account when developing models of ACP for future interventions in the primary care setting. The purpose of this study was therefore to explore ACP engagement in a study population of patients with chronic, life-limiting illness, and to understand the association between patients’ ACP engagement and their demographic and clinical characteristics, and their perceived extent of ACP-related communication with their GP.