Peripheral nerve stimulation (PNS) was the first application of neuromodulation. Widespread application of PNS was limited by technical concerns. Recent advances now allow the percutaneous placement of leads with ultrasound or fluoroscopic guidance, while the

Background: Previous research has found racial differences in hospice knowledge and misconceptions about hospice care, which may hinder access to hospice care. Asian Indians are a rapidly growing population in the United States, yet limited research has focused on their beliefs toward end-of-life care. This project investigates Indian Americans’ knowledge of and attitudes toward hospice care and advance care planning. Procedures: A cross-sectional design was employed using surveys about participants’ knowledge of and attitudes toward hospice care and advance care planning. Surveys were conducted among Indian Americans, age 60 and over, recruited from Indian cultural centers in Northern California. The participants were first asked questions about hospice care. They were then given a summary explanation of hospice care and later asked about their attitudes toward hospice care. Data were analyzed using descriptive and bivariate analyses. Results: Surveys were completed by 82 participants. Findings revealed that 42.5% of respondents had an advance directive and 57.1% had named a health care proxy. Only 10% of respondents had known someone on hospice care and 10.4% correctly answered 4-5 of the knowledge questions. After being informed about hospice care, 69.6% of participants agreed that if a family member was extremely ill, they would consider enrolling him/her in hospice. Conclusions: This study’s results present a need for greater education about hospice services among older Asian Indians. Health practitioners should remain cognizant of potential misconceptions of hospice and cultural barriers that Asian Indians may have toward hospice care, so they can tailor conversations accordingly.

Background/objectives Advance care planning (ACP) rates are low in diverse, vulnerable older adults, yet little is known about the unique barriers they face and how these barriers impact ACP documentation rates. Design Validated questionnaires listing patient, family/friend, and clinician/system‐level ACP barriers and an open‐ended question on ACP barriers. Setting Two San Francisco public/Department of Veterans Affairs hospitals. Participants One thousand two hundred and forty‐one English and Spanish‐speaking patients, aged 55 and older, with two or more chronic conditions. Measurements The open‐ended question on ACP barriers was analyzed using content analysis. We conducted chart review for prior ACP documentation. We used chi‐square/Wilcoxon rank‐sum tests and logistic regression to assess associations between ACP barriers and demographic characteristics/ACP documentation. Results Participant mean age was 65 ± 7.4 years; they were 74% from racial/ethnic minority groups, 36% Spanish‐speaking, and 36% with limited health literacy. A total of 26 barriers were identified (15 patient, 4 family/friend, 7 clinician/system‐level), and 91% reported at least one ACP barrier (mean: 5.6 ± 4.0). The most common barriers were: (patient‐level) discomfort thinking about ACP (60%), wanting to leave health decisions to “God” (44%); (family/friend‐level) not wanting to burden friends/family (33%), assuming friends/family already knew their preferences (31%); (clinician/system‐level) assuming doctors already knew their preferences (41%), and mistrust (37%). Compared with those with no barriers, participants with at least one reported barrier were more likely to be from a racial/ethnic minority group (76% vs 53%), Spanish‐speaking (39% vs 6%), with fair‐to‐poor health (48% vs 34%), and limited health literacy (39% vs 9%) (p < 0.001 for all). Participants who reported barriers were less likely to have ACP documentation (adjusted odds ratio = 0.64, 95% confidence interval [0.42, 0.98]). Conclusion English‐ and Spanish‐speaking older adults reported 26 unique barriers to ACP, with higher barriers among vulnerable populations, and barriers were associated with lower ACP documentation. Barriers must be considered when developing customized ACP interventions for diverse older adults.

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Background Advance care planning (ACP) is low among older adults with cancer. In a secondary analysis of randomized trial data, the authors compared the efficacy of the PREPARE for Your Care (PREPARE) website plus an easy‐to‐read advance directive (AD) with an AD only among older adults with and without cancer. Methods Safety net, primary care patients in San Francisco were included if they were 55 years old or older, were English‐ or Spanish‐speaking, and had 2 or more chronic conditions. The authors determined cancer diagnoses by using International Classification of Diseases, Ninth Revision/Tenth Revision codes. The primary outcome was new ACP documentation in the medical record at 15 months; the secondary outcomes were self‐reported ACP engagement, ease of use, satisfaction, and depression/anxiety. The authors used mixed effects logistic and linear regression adjusted for prior ACP, health literacy, and clinician, including a cancer interaction term. Results Of 986 participants, 220 (22%) had cancer. The mean age was 63 years (SD, 6 years), 61% were women, 81% were of a minority race/ethnicity, 45% were Spanish‐speaking, 39% had limited health literacy, and 27% had prior ACP. New ACP documentation was higher in the PREPARE arm versus the AD‐only arm among participants with cancer (62% vs 43%; P = .01) and without cancer (38% vs 28%; P = .01), as was ACP engagement in both arms (P < .001), with no interactions by cancer. Ease of use and satisfaction were high, and depression/anxiety was low, with no differences by study arm or by cancer/no cancer. Conclusions PREPARE plus an easy‐to‐read AD increased ACP documentation and engagement among diverse older adults with cancer more than an AD alone, with no increase in depression or anxiety between study arms or by cancer. PREPARE may help to decrease ACP disparities among patients with cancer. Lay Summary Advance care planning (ACP) is the process of sharing values, goals, and preferences for medical care, but engagement in ACP is low among older adults with cancer. Among 986 English‐ and Spanish‐speaking older adults from a safety net hospital, an interactive, multimedia, web‐based ACP program (PREPARE for Your Care at https://prepareforyourcare.org/) plus an easy‐to‐read advance directive increased ACP documentation and engagement more than an advance directive alone. There were no differences in this increase in ACP between older adults with cancer and older adults without cancer. Also, engaging in ACP did not result in increased depression or anxiety.