Is Annual Income a Predictor of Completion of Advance Directives (ADs) in Patients With Cancer

Saeed, Fahad; Xing, Guibo; Tancredi, Daniel J.; Epstein, Ronald M.; Fiscella, Kevin; Norton, Sally A.; Duberstein, Paul R.

doi:10.1177/1049909118813973

Cited by 16 publications

(15 citation statements)

References 53 publications

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“…Patients in the latter group were significantly more likely to have Medicaid insurance and emergency admissions. This is consistent with previous work showing an inverse relationship between income and advance directive completion, and lower completion rates among patients who are not anticipating critical illness in the near term [ 2 , 28 ].…”

Section: Discussionsupporting

confidence: 92%

Using natural language processing to identify acute care patients who lack advance directives, decisional capacity, and surrogate decision makers

et al. 2022

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The prevalence of patients who are Incapacitated with No Evident Advance Directives or Surrogates (INEADS) remains unknown because such data are not routinely captured in structured electronic health records. This study sought to develop and validate a natural language processing (NLP) algorithm to identify information related to being INEADS from clinical notes. We used a publicly available dataset of critical care patients from 2001 through 2012 at a United States academic medical center, which contained 418,393 relevant clinical notes for 23,904 adult admissions. We developed 17 subcategories indicating reduced or elevated potential for being INEADS, and created a vocabulary of terms and expressions within each. We used an NLP application to create a language model and expand these vocabularies. The NLP algorithm was validated against gold standard manual review of 300 notes and showed good performance overall (F-score = 0.83). More than 80% of admissions had notes containing information in at least one subcategory. Thirty percent (n = 7,134) contained at least one of five social subcategories indicating elevated potential for being INEADS, and <1% (n = 81) contained at least four, which we classified as high likelihood of being INEADS. Among these, n = 8 admissions had no subcategory indicating reduced likelihood of being INEADS, and appeared to meet the definition of INEADS following manual review. Among the remaining n = 73 who had at least one subcategory indicating reduced likelihood of being INEADS, manual review of a 10% sample showed that most did not appear to be INEADS. Compared with the full cohort, the high likelihood group was significantly more likely to die during hospitalization and within four years, to have Medicaid, to have an emergency admission, and to be male. This investigation demonstrates potential for NLP to identify INEADS patients, and may inform interventions to enhance advance care planning for patients who lack social support.

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Section: Discussionsupporting

confidence: 92%

Using natural language processing to identify acute care patients who lack advance directives, decisional capacity, and surrogate decision makers

et al. 2022

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“…Evidence shows that enabling characteristics, including income level and health care coverage status, are contributing factors to decreased engagement in advance care planning and directives. 33 , 65 , 67 , 67 , 272 , 273 The Nevada Behavior Risk Factor Surveillance System (BRFSS), a statewide cross-sectional survey of 4,461 adults, discovered that health insurance is the third strongest predictor of completion of advance care directives, following age and education level. 274 Furthermore, minorities and individuals with low socioeconomic statuses are less likely to have completed advance care planning and directives.…”

Section: Completion Of Advance Care Planning and Directivesmentioning

confidence: 99%

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Bazargan

Bazargan‐Hejazi

2020

Am J Hosp Palliat Care

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Objectives: Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. Methods: The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. Discussion: Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.

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“…An AD remains an important way to record the patient's desires related to treatments and interventions in their care with disease progression. 6,10–13 It is also necessary to highlight that some patients living with advanced disease do not lose their capacity and autonomy and can continue to be significantly involved in shared decision-making. Furthermore, a study in Holland on patients with formally documented ADs reported that patient perceptions of dignity and wishes remained stable over the course of the disease, thereby suggesting that the understanding of dignity had not changed substantially over time.…”

Section: Discussionmentioning

confidence: 99%

“…Advance directives (AD) are the set of wishes expressed by the patient, regarding the care and treatment they wish to receive (or not) when they are unable to express their will freely and autonomously. 6,10–13 However, even in the context of advanced disease, few patients have a formally documented AD. 5 Considering that every human being has a variety of options and opinions, based not only on their cultural environment but also on individual psychological influences, 12 the patient's concept of end-of-life dignity can be very different from those of their family caregivers and health professionals.…”

Section: Introductionmentioning

confidence: 99%

Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study

et al. 2021

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Objective To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. Methodology The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). Results Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [ p = 0.367]), methadone (9.60% vs. 4.39% [ p = 0.247]), midazolam (43.05% vs. 47.80% [ p = 0.73]), blood transfusions (31.13% vs. 24.63% [ p = 0.828]), enteral feeding (56.62% vs. 38.54% [ p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [ p = 0.435]). Conclusion This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.

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Is Annual Income a Predictor of Completion of Advance Directives (ADs) in Patients With Cancer

Cited by 16 publications

References 53 publications

Using natural language processing to identify acute care patients who lack advance directives, decisional capacity, and surrogate decision makers

Using natural language processing to identify acute care patients who lack advance directives, decisional capacity, and surrogate decision makers

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study

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