Resilience and comfort with advance care planning among adult outpatients with congenital heart disease

Background Adults with congenital heart disease (ACHD) have a lifelong health condition that may diminish quality of life (QOL) and cause serious illness. Promoting resilience and advance care planning (ACP) can both improve QOL. The relationship between resilience and patients’ comfort discussing ACP is unknown. Objectives This study evaluates the association between patients’ self-reported resilience and comfort discussing ACP. It also assesses the association between prior clinical events and resilience and comfort discussing ACP. Methods We conducted a cross-sectional study of outpatients with moderate or complex ACHD. Self-reported resilience and comfort discussing ACP were evaluated using surveys. Demographic and clinical data were collected from surveys and health records. We performed linear and logistic regression to evaluate relationships. Results Among 149 patients (41± 14 years; 52% female), 84% were non-Hispanic White and 28% had complex ACHD. Mean resilience was 29.0±7.4; 42% reported being very comfortable talking about ACP with family and friends, and 56% with their ACHD clinician. Higher resilience was associated with higher odds of feeling very comfortable discussing ACP with families and friends (OR 1.06, 95% CI 1.01–1.12, p=0.015) and ACHD clinicians (OR 1.10, 95% CI 1.04–1.15, p<0.001). Participants with prior mental health clinical events (therapist encounter, psychiatric medication prescription, mental health provider encounter) tended to report lower mean resilience and similar comfort discussing ACP. Conclusion Patients who reported higher resilience were more likely to feel comfortable discussing ACP. Strengthening resilience may be an avenue for supporting patients with ACHD to more comfortably engage in ACP.