Feasibility and acceptability of advance care planning in elderly Italian and Greek speaking patients as compared to English-speaking patients: an Australian cross-sectional study

Abstract

ObjectivesTo assess the feasibility and acceptability of facilitated advance care planning (ACP) discussions in elderly Italian and Greek-speaking inpatients compared to English-speaking inpatients.Design, setting and participantsThis cross-sectional study with convenience sampling was conducted in Melbourne, Australia, and recruited hospital inpatients with medical decision-making capacity, aged 65 years or above, who spoke Greek (25 patients), Italian (24 patients) or English (63 patients).InterventionFacilitated ACP was offered, aiming to assists patients to consider and discuss their goals, values, beliefs and future treatment wishes with their family and doctor; to help them consider how they would like healthcare decisions made in the future if they become unable to do this for themselves; and to complete advance care directives.Main outcome measuresThe completion of ACP discussions, their duration, advance care directive completion and utilisation of interpreters.ResultsOf 112 patients, 109 (97%) had at least one discussion, 63 (54%) completed advance care directives, either nominating a substitute decision-maker, documenting their wishes or both, and 76 (68%) included family in discussions. The median duration of discussions for all patients was slightly more than 1 h, over two visits. There were no differences between the Greek-speaking and the Italian-speaking patients, or between the Non-English speaking and the English-speaking patients in any of these measures. Only 14 non-English speaking patients, (30%) utilised interpreters, but when utilised, patients were much more likely (p<0.005) to complete advance care directives.ConclusionsFacilitated ACP in elderly Italian and Greek-speaking patients is feasible, acceptable and is similar to that for English-speaking patients.

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“…Absence of privacy is a barrier to ACP in hospital 33. The use of an interpreter is an important facilitator in patients from a non-English-speaking background 40. ACP documents made prior to admission are often not available or identified during an admission 30…”

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“…Detering et al. () demonstrated that when these logistical barriers were overcome through provision of interpreter services and in‐language information, ACP outcomes with Greek and Italian patients were similar to English‐speaking patients (Detering et al., ).…”

“…However, other logistical barriers may be just as important, for instance language and the ability to obtain and comprehend information related to health (Con, 2007;Shaw, Zou, & Butow, 2015;Yonashiro-Cho, Cote, & Enguidanos, 2016). Detering et al (2015) demonstrated that when these logistical barriers were overcome through provision of interpreter services and in-language information, ACP outcomes with Greek and Italian patients were similar to Englishspeaking patients (Detering et al, 2015).…”

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