Racial and Ethnic Disparities in Advance Care Planning: Assessing the Role of Subjective Life Expectancy

Lou, Yifan; Carr, Deborah

doi:10.1093/geronb/gbac003

Cited by 8 publications

(4 citation statements)

References 46 publications

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“…Recent work has suggested an effect of subjective life expectancy on informal ACP use and identified more optimistic life expectancy estimates among Black older adults and more pessimistic estimates among Hispanic older adults compared to White older adults. However, racial/ethnic differences in ACP persisted after controlling for subjective life expectancy, suggesting that other factors may play a larger role (Lou & Carr, 2022), Another alternative explanation involves unmeasured patient-provider factors. Clinicians are less likely to initiate ACP conversations with individuals with whom there are perceived or real barriers to communication (e.g., language barriers, differences in communication style, etc.)…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults

et al. 2022

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Objective To examine advance care planning (ACP) trends among an increasingly diverse aging population, we compared informal and formal ACP use by race/ethnicity among U.S. older adults (≤65 years). Methods We used Health and Retirement Study data (2012–2018) to assess relationships between race/ethnicity and ACP type (i.e., no ACP, informal ACP only, formal ACP only, or both ACP types). We reported adjusted risk ratios with 95% confidence intervals. Results Non-Hispanic Black and Hispanic respondents were 1.77 (1.60, 1.96) and 1.76 (1.55, 1.99) times as likely, respectively, to report no ACP compared to non-Hispanic White respondents. Non-Hispanic Black and Hispanic respondents were 0.74 (0.71, 0.78) and 0.74 (0.69, 0.80) times as likely, respectively, to report using both ACP types as non-Hispanic White respondents. Discussion Racial/ethnic differences in ACP persist after controlling for a variety of barriers to and facilitators of ACP which may contribute to disparities in end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults

et al. 2022

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“…Our target is that all Veterans in the participating CNH and HBPC programs are given an opportunity to discuss their goals and document their LST preferences. Several studies have documented that nonwhite patients, including Veterans, are less likely to engage in goals of care discussions and have lower rates of LST and SAPO completion [51][52][53]. Eliminating racial and ethnic disparities in the LST template and SAPO completion is important; thus, to evaluate the Reach of the PERSIVED interventions, we will compare the proportions of nonwhite/Hispanic Veterans with LST templates (HBPC) or SAPOs (CNH) vis-à-vis the white, non-Hispanic Veterans.…”

Section: Reachmentioning

confidence: 99%

Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration

Ersek

Sales

Keddem

et al. 2022

Implement Sci Commun

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Background Empirical evidence supports the use of structured goals of care conversations and documentation of life-sustaining treatment (LST) preferences in durable, accessible, and actionable orders to improve the care for people living with serious illness. As the largest integrated healthcare system in the USA, the Veterans Health Administration (VA) provides an excellent environment to test implementation strategies that promote this evidence-based practice. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) program seeks to improve care outcomes for seriously ill Veterans by supporting efforts to conduct goals of care conversations, systematically document LST preferences, and ensure timely and accurate communication about preferences across VA and non-VA settings. Methods PERSIVED encompasses two separate but related implementation projects that support the same evidence-based practice. Project 1 will enroll 12 VA Home Based Primary Care (HBPC) programs and Project 2 will enroll six VA Community Nursing Home (CNH) programs. Both projects begin with a pre-implementation phase during which data from diverse stakeholders are gathered to identify barriers and facilitators to adoption of the LST evidence-based practice. This baseline assessment is used to tailor quality improvement activities using audit with feedback and implementation facilitation during the implementation phase. Site champions serve as the lynchpin between the PERSIVED project team and site personnel. PERSIVED teams support site champions through monthly coaching sessions. At the end of implementation, baseline site process maps are updated to reflect new steps and procedures to ensure timely conversations and documentation of treatment preferences. During the sustainability phase, intense engagement with champions ends, at which point champions work independently to maintain and improve processes and outcomes. Ongoing process evaluation, guided by the RE-AIM framework, is used to monitor Reach, Adoption, Implementation, and Maintenance outcomes. Effectiveness will be assessed using several endorsed clinical metrics for seriously ill populations. Discussion The PERSIVED program aims to prevent potentially burdensome LSTs by consistently eliciting and documenting values, goals, and treatment preferences of seriously ill Veterans. Working with clinical operational partners, we will apply our findings to HBPC and CNH programs throughout the national VA healthcare system during a future scale-out period.

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“…The National Coalition for Hospice and Palliative Care 1 has identified culturally appropriate end-of-life (EOL) care planning as a US national priority. Racial and ethnic disparities in EOL care planning are well documented 2-4 . Rao et al 5 found that only 18% of diverse patients had an advance directive (AD), as compared with 34% of Whites.…”

mentioning

confidence: 99%

“…Racial and ethnic disparities in EOL care planning are well documented. [2][3][4] Rao et al 5 found that only 18% of diverse patients had an advance directive (AD), as compared with 34% of Whites.…”

mentioning

confidence: 99%

Advance Care Planning Engagement Strategies for Primary Care Providers Seeing Diverse Patient Populations

Kirkpatrick,

Buccheri,

Sharifi

2023

J Hosp Palliat Nurs

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Diverse patients are less likely than Whites to have advance care planning. The primary purpose of this scoping review was to summarize recent evidence about advance care planning engagement interventions for primary care providers working with diverse patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) Checklist was followed. Peer-reviewed articles published in English since 2000 reporting the results of studies testing intervention programs in primary care to improve advance care planning with adult, racially diverse populations were included. Searches were conducted in 5 online databases and yielded 72 articles. Gray literature yielded 23 articles. Two authors independently reviewed the abstracts of 72 articles determining that 9 articles met the aim of this review. These studies were analyzed by communication tools and other resources, population, intervention, primary outcomes, instruments, and primary findings and organized into 3 categories: (a) provider-focused interventions, (b) patient-focused interventions, and (c) multilevel interventions. Improvement in advance care planning outcomes can be achieved for racially diverse populations by implementing targeted advance care planning engagement interventions for both providers and patients. These interventions can be used in primary care to increase advance care planning for diverse patients. More research is needed that evaluates best practices for integrating advance care planning into primary care workflows.

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Racial and Ethnic Disparities in Advance Care Planning: Assessing the Role of Subjective Life Expectancy

Cited by 8 publications

References 46 publications

Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults

Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults

Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration

Advance Care Planning Engagement Strategies for Primary Care Providers Seeing Diverse Patient Populations

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