A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South

Huang, Chao-Hui; Crowther, Martha R.; Allen, Rebecca S.; DeCoster, Jamie; Kim, Giyeon; Azuero, Casey B.; Ang, Xinying; Kvale, Elizabeth

doi:10.1089/jpm.2015.0334

Cited by 44 publications

(71 citation statements)

References 28 publications

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“…A recent study demonstrated an online patient-centered platform (PREPARE) that provides communication and decisionmaking training might increase likelihood of ACP among non-white older adults [63]; similarly, implementation of a personal health record tool resulted in increased ACP documentation rates in this population [64]. Recently, Huang and colleagues documented that motivational interviewing techniques increased ACP documentation among African Americans in the south [65]. In their randomized control trial, intervention participants received a one-time 90-min intervention, during which client-centered motivational techniques were used to enhance awareness and engagement with ACP documentation [65].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Huang and colleagues documented that motivational interviewing techniques increased ACP documentation among African Americans in the south [65]. In their randomized control trial, intervention participants received a one-time 90-min intervention, during which client-centered motivational techniques were used to enhance awareness and engagement with ACP documentation [65]. Future interventions should evaluate this approach among older African Americans in urban settings such as Baltimore City.…”

Section: Discussionmentioning

confidence: 99%

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Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore

et al. 2017

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Advance care planning (ACP) is the process of planning for when individuals are unable to make their own healthcare decisions. Research suggests ACP is understudied among HIV-positive African Americans. We explored ACP knowledge, preferences, and practices with HIV-positive African Americans from an urban HIV-specialty clinic (AFFIRM study). Participants completed surveys and interviews. Descriptive analyses and Poisson regression were conducted on survey data. Qualitative interviews were coded using grounded theory/constant comparative method. Participants were mostly male (55.1%). Half rated their current pain as at least six out of ten (50.8%). Two-thirds had discussed ACP with providers or supporters (66.2%). Qualitative themes were: (1) impact of managing pain on quality of life and healthcare, (2) knowledge/preferences for ACP, and (3) sources of HIV supportive care and coping (N = 39). Correlates of having discussed ACP included: moderate pain intensity (p < 0.10), including supporters in health decisions (p < 0.001), religious attendance (p < 0.05), and knowledge of healthcare mandates (p < 0.01; N = 276). Findings highlight the need for patient education to document healthcare preferences and communication skills development to promote inclusion of caregivers in decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore

et al. 2017

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“…41 Health care teams should therefore tailor advance care planning conversations to account for these cultural, educational and social support differences to effectively engage minority populations in the advance care planning process. 42 For example, Song et al randomized an advance care planning intervention among Black and White hemodialysis patients and their surrogates. 43 Specifically, the intervention aimed to discern the emotional and spiritual beliefs that patients and family members had in relation to the illness.…”

Section: Discussionmentioning

confidence: 99%

Health Literacy Mediates Racial Disparities in Cardiopulmonary Resuscitation Knowledge among Chronic Kidney Disease Patients

Eneanya¹,

Olaniran²,

Xu³

et al. 2018

Journal of Health Care for the Poor and Underserved

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Black patients with chronic kidney disease (CKD) receive more cardiopulmonary resuscitation (CPR) than other racial groups, and knowledge of CPR influences preferences for care. As limited health literacy disproportionately affects Blacks and contributes to disparities in end-of-life (EOL) care, we investigated whether health literacy mediates racial disparities in CPR knowledge. Black and White adult patients with advanced CKD completed CPR knowledge surveys. Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine. Among 149 patients, Black patients were more likely to have limited health literacy and lower mean CPR knowledge scores than White patients. In adjusted analyses, health literacy mediated racial differences in CPR knowledge. Knowledge of CPR is lower among Black compared with White CKD patients and health literacy is a mediator of this difference. Future CPR educational interventions should target health literacy barriers to improve informed decision-making and decrease racial disparities at the end-of-life.

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“…Studies of Respecting Choices have shown an increase in the prevalence of advance directives, greater patient-surrogate congruence for treatment preferences, receipt of goal-concordant care, and decrease in health care utilization. [21][22][23][24] A recent systematic review of Respecting Choices and related models noted limitations in research methods and inconsistency in findings related to ACP outcomes across published studies. 25 In addition, evidence on its use and outcomes in minority populations is limited.…”

Section: Interventionmentioning

confidence: 99%

“…25 In addition, evidence on its use and outcomes in minority populations is limited. 21,22 The Respecting Choices model includes three stages of ACP, First Steps, Next Steps, and Last Steps. First Steps is intended for those who have not planned.…”

Section: Interventionmentioning

confidence: 99%

Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol

Ejem

Barrett

Rhodes

et al. 2019

Journal of Palliative Medicine

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Advance care planning (ACP) improves end-of-life care for patients and their caregivers. However, only one-third of adults have participated in ACP and rates are substantially lower among African Americans than among whites. Importantly, ACP improves many domains of care where there are racial disparities in outcomes, including receipt of goal-concordant care, hospice use, and provider communication. Yet, few studies have examined the effectiveness of ACP interventions among African Americans. The objectives of reducing disparities in the quality of palliative care for older African Americans through improved advance care planning (EQUAL ACP) are as follows: to compare the effectiveness of two interventions in (1) increasing ACP among African Americans and whites and (2) reducing racial disparities in both ACP and end-of-life care; and to examine whether racial concordance of the interventionist and patient is associated with ACP. EQUAL ACP is a longitudinal, multisite, cluster randomized trial and a qualitative study describing the ACP experience of participants. The study will include 800 adults ‡65 years of age (half African American and half white) from 10 primary care clinics in the South. Eligible patients have a serious illness (advanced cancer, heart failure, lung disease, etc.), disability in activities of daily living, or recent hospitalization. Patients are followed for one year and participate in either a patient-guided, self-management ACP approach, including a Five Wishes form or structured ACP with Respecting Choices First Steps. The primary outcome is formal or informal ACP-completion of advance directives, documented discussions with clinicians, and other written or verbal communication with surrogate decision makers about care preferences. Secondary outcomes assessed through after-death interviews with surrogates of patients who die during the study include receipt of goal-concordant care, health services use in the last year of life, and satisfaction with care. EQUAL ACP is the first large study to assess which strategies are most effective at both increasing rates of ACP and promoting equitable palliative care outcomes for seriously ill African Americans.

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A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South

Abstract: Feasibility data revealed successful implementation of a brief intervention to increase ACP engagement and willingness to complete an AD among southern African Americans.

Cited by 44 publications

References 28 publications

Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore

Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore

Health Literacy Mediates Racial Disparities in Cardiopulmonary Resuscitation Knowledge among Chronic Kidney Disease Patients

Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol

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