An advance directive redesigned to meet the literacy level of most adults: A randomized trial

Sudore, Rebecca L.; Landefeld, C. Seth; Barnes, Deborah E.; Lindquist, Karla; Williams, Brie; Brody, Robert V.; Schillinger, Dean

doi:10.1016/j.pec.2007.08.015

Cited by 120 publications

(189 citation statements)

References 37 publications

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“…In addition, some other alternative predictors of interest could not be examined, such as access to information on advance directives, 7,9,11 the quality of the patient-provider relationship, 1,4,24,25 and health literacy (as distinct from educational attainment). 26,27 In summary, low adoption of advance directives among black older Americans (as compared with white older Americans) is not explained by other demographic factors, religious characteristics, or personal health values. As a matter of policy, these findings support targeted efforts and reimbursement models to promote advance care planning among members of underserved groups, as an individual's religious beliefs and personal health values do not fully explain the racial difference in advance directive possession.…”

Section: Discussionmentioning

confidence: 91%

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

Huang

Neuhaus

Chiong

2016

Journal of Palliative Medicine

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Background: Black and Hispanic older Americans are less likely than white older Americans to possess advance directives. Understanding the reasons for this racial and ethnic difference is necessary to identify targets for future interventions to improve advance care planning in these populations. Methods: The aim of the study was to evaluate whether racial and ethnic differences in advance directive possession are explained by other demographic factors, religious characteristics, and personal health values. A general population survey was conducted in a nationally representative sample using a web-enabled survey panel of American adults aged 50 and older (n = 2154). Results: In a sample of older Americans, white participants are significantly more likely to possess advance directives (44.0%) than black older Americans (24.0%, p < 0.001) and Hispanic older Americans (29.0%, p = 0.006). Gender, age, retired or disabled employment status, educational attainment, religious affiliation, Internet access, preferences for physician-centered decision making, and desiring longevity regardless of functional status were independent predictors of advance directive possession. In fully adjusted multivariable models with all predictors included, black older Americans remained significantly less likely than white older Americans to have an advance directive (odds ratio [OR] = 0.42, 95% confidence interval [CI] = 0.24-0.75), whereas the effect of Hispanic ethnicity was no longer statistically significant (OR = 0.65, 95% CI = 0.39-1.1). Conclusion: In a nationally representative sample, black race is an independent predictor for advance directive possession. This association remains even after adjustment for other demographic variables, religious characteristics, and personal health values. These findings support targeted efforts to mitigate racial disparities in access to advance care planning.

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Section: Discussionmentioning

confidence: 91%

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

Huang

Neuhaus

Chiong

2016

Journal of Palliative Medicine

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“…9 Subjects were recruited between August and December 2004, using convenience sampling, from an urban, county general medicine clinic in San Francisco. Participants were eligible if they were 50 years of age or older and reported fluency in English or Spanish.…”

Section: Methodsmentioning

confidence: 99%

Reach and Impact of a Mass Media Event Among Vulnerable Patients: The Terri Schiavo Story

et al. 2008

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BACKGROUND: It is unknown whether health-related media stories reach diverse older adults and influence advance care planning (ACP). OBJECTIVE:To determine exposure to media coverage of Terri Schiavo (TS) and its impact on ACP. DESIGN AND PARTICIPANTS:Descriptive study of 117 English/Spanish-speakers, aged ≥50 years (mean 61 years) from a county hospital, interviewed six months after enrollment into an advance directive study. MEASUREMENTS:We assessed whether participants had heard of TS and subject characteristics associated with exposure. We also asked whether, because of TS, subjects engaged in ACP.MAIN RESULTS: Ninety-two percent reported hearing of TS. Participants with adequate literacy were more likely than those with limited literacy to report hearing of TS (100% vs. 79%, P<.001), as were participants with ≥ a high school vs. < high school education (97% vs. 82%, P=.004), and English vs. Spanish-speakers (96% vs. 85%, P=.04). Because of TS, many reported clarifying their own goals of care (61%), talking to their family/friends about ACP (66%), and wanting to complete an advance directive (37%).CONCLUSIONS: Most diverse older adults had heard of TS and reported that her story activated them to engage in ACP. Media stories may provide a powerful opportunity to engage patients in ACP and develop public health campaigns.KEY WORDS: mass media; public health; advance care planning; health literacy; vulnerable populations.

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“…Our intervention addresses limited health literacy by providing English and Spanish language materials that are targeted for a low literacy population by using simple language, bulleted points, and pictures/cartoons to illustrate information. 42 …”

Section: Improving Advance Care Planning Communication For Latinosmentioning

confidence: 99%

Advance Directive Discussions: Lost in Translation or Lost Opportunities?

Fischer

Sauaia

Min

et al. 2012

Journal of Palliative Medicine

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Background: Previous studies have shown that minority populations have low rates of documented advance directives and express preferences for more life-prolonging interventions at the end of life. We sought to determine the impact of Latino ethnicity on patients' self-report of having an advance directive discussion and having a completed advance directive in the medical record at an index hospitalization for serious medical illness. Methods: This was a prospective observational cohort study of 458 adults admitted to the general medical services of a safety net hospital, an academic medical center, and a Veterans' Affairs (VA) hospital. Patients were asked if they had discussed advance directives, and we reviewed medical records for documented advance directives. Results: Overall, 45% of patients reported having had a discussion about advance directives (29% of Latinos compared with 54% of Caucasians, p = 0.0002) and 24% of patients had a completed advance directive in their medical record (25% Latinos and 26% of Caucasians, p = not significant [ns]). Using logistic regression modeling and adjusting for socioeconomic status (SES), education level, and language spoken, Latinos (odds ratio [OR] 0.42, confidence interval [CI] 0.24-0.75) were less likely to report having advance directive discussions compared with Caucasians (referent). However, modeling of a completed advance directive in the medical record showed no significant difference between Latinos (OR 1.44, CI 0.73-2.85) and Caucasians (referent). Conclusions: The unexpected discrepancy we found highlights the need for more effective communication in advance care planning that includes education that is culturally sensitive and accessible to persons with low health literacy.

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An advance directive redesigned to meet the literacy level of most adults: A randomized trial

Cited by 120 publications

References 37 publications

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

Reach and Impact of a Mass Media Event Among Vulnerable Patients: The Terri Schiavo Story

Advance Directive Discussions: Lost in Translation or Lost Opportunities?

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