End-of-life preferences and presence of advance directives among ethnic populations with severe chronic cardiovascular illnesses

Piamjariyakul, Ubolrat; Myers, Sarah; Werkowitch, Marilyn; Smith, Carol E.

doi:10.1177/1474515113519523

Cited by 13 publications

(19 citation statements)

References 30 publications

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“…The web-based testing platform limited our ability to qualitatively explore individual participants' rationales for either having or not having advance directives. 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.…”

Section: Discussionmentioning

confidence: 99%

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

102

100

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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: 99%

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

102

100

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“…8–11 The results from HF patients, their family members, and multidisciplinary HF professionals in our focus groups indicated critical needs for family discussions of EOL care options. 12 Little is known about the impact of palliative consultation on outcomes for minority patients. However, it is known that EOL care for those with HF must encompass specific challenges of this disease.…”

Section: Care Options At the Eolmentioning

confidence: 99%

“…This intervention is based on the synthesis of the literature and our multidisciplinary research team’s past pilot study results to address EOL care for end-stage HF patients that aligns with the preferences of patients and their family members. 11,12 …”

Section: Purposementioning

confidence: 99%

“…4,19 The overwhelming number of patients do not want extraordinary futile care, 20 yet most African American patients do not have an advance directive, professional guidance, or discussions of EOL options specific to HF decline. 11,12,21 …”

Section: Synthesis Of the Literature And Preliminary Studiesmentioning

confidence: 99%

“…21 Therefore, it is important for them to understand that hospice care at home supports families who play a major role in the patient’s EOL care and in any decision making. 12 Some studies, but not all, have found the use of hospice care is accompanied by a decrease in the cost to families for EOL home care. 5 …”

Section: Synthesis Of the Literature And Preliminary Studiesmentioning

confidence: 99%

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Designing and Testing an End-of-Life Discussion Intervention for African American Patients With Heart Failure and Their Families

Piamjariyakul

Smith

Werkowitch

et al. 2016

J Hosp Palliat Nurs

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There is an escalating prevalence of heart failure (HF) with high mortality. Compared with other races, African Americans face a higher incidence of HF at earlier age of onset, with more rapid progression, and with increased family care burden and greater care costs and disparity in health care services at the end of life (EOL). Concomitant out-of-pocket HF costs and care demands indicate the need for early discussion of palliative and EOL care needs. We therefore developed and pilot tested a culturally sensitive intervention specific to the needs of African American HF patients and their families at the EOL. Our pilot study findings encompass patient and caregiver perspectives and align with the state of EOL science. The ultimate long-term goal of this intervention strategy is to translate into practice the preferred, culturally sensitive, and most cost-efficient EOL care recommendations for HF patients and families.

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Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans

et al. 2015

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End-of-life preferences and presence of advance directives among ethnic populations with severe chronic cardiovascular illnesses

Abstract: Most of these very ill patients did readily discuss these sensitive issues with the research nurse. Cardiovascular training in end-of-life care should include sensitivity to ethnic and cultural preferences and competencies in interviewing on sensitive topics.

Cited by 13 publications

References 30 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

Designing and Testing an End-of-Life Discussion Intervention for African American Patients With Heart Failure and Their Families

Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans

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