Advance care planning among ethnic/racial minority older adults: Prevalence of and factors associated with informal talks, durable power of attorney for health care, and living will

2020 ◽  
pp. 1-10 ◽  
Author(s):  
Michin Hong ◽  
Kyeongmo Kim
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Advance Care Planning ◽  
Living Will ◽  
Racial Minority ◽  
Care Planning ◽  
Power Of Attorney ◽  
Factors Associated ◽  
Durable Power Of Attorney ◽  
Advance Care

Health-Care Provider Personal Religious Preferences and Their Perspectives on Advance Care Planning With Patients

2018 ◽  
Vol 35 (12) ◽  
pp. 1565-1571
Author(s):  
Marjorie Bowman ◽  
Sarah St. Cyr ◽  
Adrienne Stolf i
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Religious Affiliation ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Power Of Attorney ◽  
Religious Preference ◽  
Advance Care

Objective: To understand how health-care providers’ (HCPs) religious preferences influence their willingness to undertake advance care planning (ACP) with patients and their acceptance of other HCP’s involvement. Methods: Online anonymous survey distributed to HCPs in hospital, ambulatory offices, and hospice settings in Dayton, Ohio. We evaluated the associations of HCP religion with their personal ACP, willingness to facilitate ACP, and acceptance of other HCPs’ ACP participation. Results: 704 respondents: nurses (66.2%), physicians (18.8%), other HCPs (15.0%), white (88.9%), and primarily Catholic (23.3%) or Protestant (32.0%). “No religion” was marked by 13.9%. Respondents were favorable to ACP with patients. Religious respondents were more likely to have a living will ( P = .035) and health-care power of attorney ( P = .007) and more accepting of clergy as ACP decision coaches ( P = .030). HCP’s religion was not associated with willingness to facilitate ACP discussions. There were minor differences between Catholics and Protestants. Conclusions: Personal religious preference is associated with HCP’s own ACP but had little relationship with their willingness to facilitate ACP conversations with patients or acceptance of other professional types of HCPs involvement in ACP conversations. Regardless of religious affiliation, HCPs have interest in undertaking ACP and endorse other HCPs ACP involvement. As results of this study suggest that personal religious affiliation is not a barrier for HCPs engaging in ACP with patients, attempts to overcome barriers to increasing ACP should be directed to other factors.

Advance care planning among older LGBT Canadians: Heteronormative influences

Sexualities ◽  
2020 ◽  
pp. 136346071989696
Author(s):  
Brian de Vries ◽  
Gloria Gutman ◽  
Shimae Soheilipour ◽  
Jacqueline Gahagan ◽  
Áine Humble ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advance Care Planning ◽  
Cultural Context ◽  
Death And Dying ◽  
Living Will ◽  
Community Dwelling ◽  
Care Planning ◽  
Power Of Attorney ◽  
Advance Care

Advance care planning (ACP) in North America often takes place in a cultural context of great ambivalence about death and dying, challenging efforts to discuss end-of-life care desires and preparations for death. Such challenges are amplified for sexual and gender minority older adults who often lack connections to traditional heteronormative systems of support. The extent of ACP preparation (completed documents, discussions) and their predictors was examined among a national sample of 91 community-dwelling Canadian LGBT older adults (mean age 68). The sample was disproportionately single and lived alone; more trans participants had children and about half of all participants reported a chosen family. About two-thirds of participants had a will, while less than half had a living will and power of attorney for health care, and a quarter had made informal caregiving arrangements. Just over one-third of respondents reported having discussions about future care and end-of-life plans. The only significant predictors of both ACP documents completed and ACP discussions undertaken were relationship status (those in a relationship were more likely to have engaged in both) and number of children (those with children were less likely to have completed documents). Given that most LGBT older adults are single, efforts must be expanded to reach and engage these individuals in preparing for end of life.

Understanding patient advance directives status in a community oncology practice using an electronic patient-reported outcomes (ePRO) system.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23181-e23181
Author(s):  
Joanne S. Buzaglo ◽  
Karen E Skinner ◽  
Edward Stepanski ◽  
Cynthia Tankersley ◽  
Lee S. Schwartzberg
Keyword(s):  
Cancer Patients ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Initial Visit ◽  
Power Of Attorney ◽  
Durable Power Of Attorney ◽  
Advance Care ◽  
Oncology Practice

e23181 Background: The National Comprehensive Cancer Network and the American Society of Clinical Oncology recommend that providers encourage early advance care planning with their patients1; yet, many cancer patients do not have advance directives (ADs). A potential reason for low AD rates is inadequate communication between the provider and patient. To address this gap, we developed an outpatient clinic AD initiative for any stage cancer patients via an ePRO system. The AD module was designed to ensure that patients are aware of ADs and to assess whether or not the patient had ADs, specifically a Living Will and/or a durable power of attorney. The study purpose was to assess patient AD status at the patient’s initial visit to an oncology clinic. Methods: This study used a retrospective, observational design that involved use of PRO and clinical data collected via the Patient Care Monitor™ (PCM), a web-based ePRO system linked to electronic medical record data. All data used in this study were collected as part of routine clinical care. All patients at an initial visit to an oncology clinic completed the PCM survey, including the AD module, via a handheld e-tablet. Results: Overall, 9,682 patients completed the AD module (mean age 63; 31% male/69% female; 58% married; 62% White, 35% Black). Cancer type was known for 75% of all patients (29% breast, 11% hematologic, 7% lung, 7% colorectal, 3% prostate, 17% other types). One third of all patients (33%) reported having an AD at the time of the initial visit to the oncology clinic, specifically 24% indicated having a Living Will and 9% a durable power of attorney. The remaining two-thirds (67%) indicated either NOT having an AD (56%) or not knowing if they had an AD (11%). Patients with ADs were more likely to be older ( M=68 v. 60 yrs), male (38% v 31%), White (41% v 20% Black) and married/partnered (35% v 29%); ps <.0001. Conclusions: This study demonstrates that the majority of patients do not have ADs at the time of an initial visit to a community-based oncology practice. Using an ePRO system can be an innovative and efficient way to identify unmet needs of patients and link them to resources for developing advance directives. 1Brown AJ, Shen MJ, Urbauer D, et al. Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients. Gynecol Oncol. Sep 2016;142(3):525-530.

Examining Racial Differences in the Informal Discussion of Advance Care Planning Among Older Adults: Application of the Andersen Model of Health Care Utilization

2021 ◽  
pp. 073346482199361
Author(s):  
Zainab Suntai ◽  
Hyunjin Noh ◽  
Cho Rong Won
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Racial Differences ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Utilization ◽  
Care Planning ◽  
Life Care ◽  
Power Of Attorney ◽  
Advance Care

Objectives: The purpose of this study was to examine racial differences in the discussion of advance care planning among older adults using Andersen’s behavioral model of health care utilization. Method: This cross-sectional study utilized data from the 2018 National Health and Aging Trends Study. Weighted multivariable logistic regressions were used to predict advance care planning discussion ( n = 1,326). Results: After accounting for predisposing, enabling, and need factors, Black older adults were less likely to discuss end-of-life care (odds ratio [OR] = .527) and medical power of attorney (OR = .531) compared with Whites. Hispanic older adults were also less likely to discuss end-of-life care (OR = .389) and power of attorney (OR = .384) compared with Whites. Discussion: These results point to significant racial disparities in advance care planning discussions among older adults and call for future examinations of cultural, historical, and systemic factors that could influence the discussion of advance care planning among this population.

Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations

2020 ◽  
Vol 76 (1) ◽  
pp. 104-108
Author(s):  
Kathrin Boerner ◽  
Sara M Moorman ◽  
Deborah Carr ◽  
Katherine A Ornstein
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Multinomial Logistic Regression ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Abstract Objectives Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP. Method Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP. Results A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one’s only preparation or in tandem with formal preparations. Discussion Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

scholarly journals Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Deborah Carr
Keyword(s):  
Life Expectancy ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Risk Of Death ◽  
Advance Care ◽  
Survival Expectations ◽  
The Impact

Abstract The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

scholarly journals Patient Perspectives on Advance Care Planning via a Patient Portal

2019 ◽  
Vol 36 (8) ◽  
pp. 682-687 ◽  
Author(s):  
Sarah R. Jordan ◽  
Adreanne Brungardt ◽  
Phoutdavone Phimphasone-Brady ◽  
Hillary D. Lum
Keyword(s):  
Health Care ◽  
Advance Care Planning ◽  
Clinical Care ◽  
Patient Perspectives ◽  
Medical Decision ◽  
Patient Portal ◽  
Care Planning ◽  
Power Of Attorney ◽  
Regional Health Care ◽  
Advance Care

Background:Patient portals can offer patients an opportunity to engage in the advance care planning (ACP) process outside of clinical visits.Objective:To describe patient perspectives on use of patient portal-based ACP tools.Design:Interviews with patients who used portal-based ACP tools. The tools included an electronic Medical Durable Power of Attorney (MDPOA) form to designate a medical decision maker, a patient-centered educational web page, online messaging, and patient access to completed advance directives stored in the electronic health record (EHR).Setting:Regional health-care system with a common EHR.Measurements:Semistructured interviews with purposefully sampled patients who used the ACP tools. Questions explored motivations for using the tools and perceptions about how the tools fit into ACP. Analysis followed a grounded hermeneutic editing approach.Results:From 46 patients (mean age: 49, 63% female), 4 key themes emerged: (1) individualized explorations of the ACP tools, (2) personal initiation and engagement with ACP tools through the portal, (3) value of connecting ACP portal tools to clinical care, and (4) practicality of the ACP tools. Patients described benefits of communicating with health-care team members who referred them to online ACP tools, as well as having the electronic MDPOA form connected to clinical care.Conclusions:Patients considered the portal-based ACP tools to be practical and feasible to use within the scope of their own ACP experiences. Further study is needed to understand whether portal-based ACP tools increase the quality and quantity of ACP conversations and documentation that is available to inform medical decision-making.

scholarly journals The Role of Health, Social Network, and Race in Advance Care Planning Among Medicare Beneficiaries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 69-70
Author(s):  
Jung Kwak ◽  
Heehyul Moon ◽  
Soonhee Roh
Keyword(s):  
Older Adults ◽  
Social Network ◽  
African Americans ◽  
Advance Care Planning ◽  
Living Will ◽  
Individual Characteristics ◽  
Care Planning ◽  
Medicare Beneficiaries ◽  
Advance Care

Abstract Advance care planning (ACP) is linked with high-quality end-of-life outcomes. However, ACP engagement level among older adults varies significantly by demographic, social, and health characteristics. In this study, we sought to identify characteristics associated with informal and formal ACP, in order to inform development of targeted education and outreach efforts that are tailored to diverse groups of older adults. The data came from a nationally representative study of Medicare beneficiaries living in communities, the National Health and Aging Trends Study (Round 8, N= 5,547). Multivariable logistic regressions were conducted to identify individual characteristics (i.e., race/ethnicity, age, gender, income, functional disability, cognitive function, perceived health, and numbers of people in social networks) associated with ACP engagement. Rates of informal ACP (talking to someone), and formal ACP, completing a healthcare power of attorney (HPOA) and a living will (LW), were 56%, 60.5%, and 56% accordingly. Logistic regression showed that individuals who were married or had a larger social network, and had higher functional impairment and health needs were significantly more likely to engage in both informal and formal ACP. However, individuals with memory problems (only informal ACP) and African Americans and Hispanics were significantly less likely to engage in both informal and formal ACP. African Americans without dementia were more likely to have completed HPOA compared with Whites. Findings suggest an important role of social network, and functional and cognitive health in ACP with implications for developing targeted outreach efforts in faith-based or social group settings, and healthcare settings.

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