Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial

Abstract

Background: End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented. Objective: The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members. Methods: We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation. Results: Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects. Conclusion: When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.

Financial Hardship and Health Related Quality of Life Among Older Latinos With Chronic Diseases

“…This cross-sectional study used baseline data collected from a pilot randomized clinical trial; and the methods for this study have been reported elsewhere. 25 This study received IRB approval from New Mexico State University review board. Participants were screened and provided written informed consent prior to participating in this study and were provided a $20 gift-card after they completed the study as a token of appreciation for sharing their perspectives and time.…”

What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials

“…Documentation of ACP/AD: 54 RCTs evaluated documentation of ACP or AD 24 29–31 35 40–43 59 61 64 68 71 74 81 82 86 91 101 110–112 118–148. Of the 34 (63%) showing a positive and significant effect of the intervention on documentation, 20 were high-quality, 24 (71%) were communication interventions24 30 31 35 41 42 59 64 68 91 101 111 112 118–128 including 1 with a decision aid component,118 8 were decision aids only82 86 129–134 and 2 were AD-only interventions 43 135…”

Complex advance care planning interventions for chronic serious illness: how do they work? a scoping review

“…Of the 16 studies retained (online supplemental table 1), the largest portion (11 studies) made use of an interview or conversation to address the topic of ACP. [28][29][30][31][32][33][34][35][36][37][38] Conversations were led by facilitators including (trained) nurses, 28 29 32 34-36 38 psychologists, 31 32 37 social workers [31][32][33] or graduate students. 31 32 Five conversation interventions also included the provision of conversation summaries and/or ADs completed during the conversation to the healthcare provider (general practitioner or treating physician) or placement of documentation in the patient's health record.…”

“…One study reported that, additionally, Latinos may not want to burden family members with distressing issues such as end-of-life conversations. 33 Attending to barriers such as those posed by language and health literacy can increase the likelihood of intervention success. 40 The authors of six studies reflected on the impact of the patient's illness experience on study outcomes.…”