This study examined an intervention to help high-functioning community-dwelling older people communicate their wishes for care at the end of life with someone they would trust to make health care decisions for them if necessary. Groups consisted of dyads of older people and their potential or designated health care agents randomly assigned to the intervention (STEP program) or control group. STEP participants received three group sessions with educational and support components. For individual participants, there was a statistically significant difference between groups on knowledge of the health care proxy form and the roles and responsibilities of the agent. For the dyads of older people and their agents, there was a significantly higher mean communication score for the STEP participants than for the control group. The findings demonstrate that it is possible to affect advance communication about wishes at the end of life through a group intervention.
The purpose of this study was to determine which of two educational interventions delivered in Spanish would influence Latino elders' attitudes toward and comfort with end-of-life planning in comparison with a control group receiving only standard information routinely provided. Using a posttest-only control group design, elders receiving home care services who agreed to participate were randomly assigned to one of three groups: Conversación A; Conversación B, with culturally relevant material added; and a control group. A one-way multivariate analysis of variance was conducted to determine the effect on the two dependent variables: attitudes toward end-of-life planning and comfort with end-of-life planning. Significant differences were found among the three groups on both outcome measures. Attitudes toward advance planning scores were significantly higher for both intervention groups compared with the control group. Although both intervention groups had higher comfort scores than the control group, only the Conversación A score was statistically different from that of the control group. The results of this study indicate that it may be possible to positively influence both attitudes toward and comfort with end-of-life planning among older Latinos receiving home care, through the use of a one-to-one protocol that is delivered in Spanish.
This study used focus groups to understand Hispanic elders' and adult children's concerns about end-of-life planning. Ten older persons participated in the elders group, and ten adult children in a separate group. Themes in both groups included communication, control, burden, spirituality, religious issues, and importance of family relationships. Communication regarding end-of-life planning was of particular importance to both elders and adult children. The most striking indication of the challenges in communication about end-of-life issues is the insistence by both the elders and the adult children that their children/ parents do not want to have these discussions.
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