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.

Racial Differences in End-Of-Life Planning: Why Don'T Blacks and Latinos Prepare for the Inevitable?

2011 ◽  
Vol 63 (1) ◽  
pp. 1-20 ◽  
Author(s):  
Deborah Carr
Keyword(s):  
End Of Life ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Ethnic Disparities ◽  
Chronically Ill ◽  
Living Will ◽  
Treatment Preferences ◽  
Care Planning ◽  
Power Of Attorney ◽  
Advance Care

I evaluate the extent to which ethnic disparities in advance care planning reflect cultural and religious attitudes and experience with the painful deaths of loved ones. Data are from a sample of 293 chronically ill older adults who are seeking care at one of two large medical centers in urban New Jersey. Blacks and Hispanics are significantly less likely than Whites to have a living will, a durable power of attorney for health care (DPAHC), and to have discussed their end of life treatment preferences. Multivariate analyses reveal that the Black-White gap in advance care planning is largely accounted for by Blacks' belief that God controls the timing and nature of death. The Hispanic-White gap is partially accounted for by the belief that one's illness negatively affects one's family. Ethnic disparities are starkest for living will and DPAHC use, and less pronounced for discussions. Implications for policy and practice are discussed.

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.

Facilitators and barriers to advance care planning in oncology.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 84-84 ◽  
Author(s):  
Joanna Paladino ◽  
Rachelle Bernacki ◽  
Mathilde Hutchings ◽  
J. Andrew Billings ◽  
Susan Block
Keyword(s):  
Advance Care Planning ◽  
Controlled Trial ◽  
Care Planning ◽  
Course Of Illness ◽  
Risk Of Death ◽  
Advance Care ◽  
Facilitators And Barriers ◽  
Cluster Randomized ◽  
Seriously Ill Patients ◽  
The Impact

84 Background: For seriously ill patients to plan for the end of life, they need to discuss with their clinicians their prognosis, values, and goals, yet such conversations often begin very late in the course of illness. To promote early advance care planning (ACP) in oncology, facilitators and barriers to these conversations need to be identified. Objectives: 1. To determine the effectiveness of “triggers” that remind oncologists to complete ACP discussions with outpatients whom they expect might die within a year. 2. To prospectively evaluate clinician-identified barriers to these conversations. Methods: A cluster-randomized controlled trial. The intervention includes: clinician identification of patients at high risk of death within a year; 2½ hour training program on the use of the Serious Illness Conversation Guide; an email trigger/reminder, immediately before an outpatient visit, for the oncologist to conduct an ACP discussion using the Conversation Guide; clinician reports of why they deferred such conversations. Results: Eighty-eight enrolled oncology clinicians (MDs, NPs, PAs) screened 15,576 patients and identified 1,743 for whom they would not be surprised about death within a year. To date, 332 patients have consented to enrollment; 104 patients and 40 clinicians entered the intervention arm; 124 subsequent visits were triggered, resulting in 62 completed conversations. 79% of the conversations occurred after 1 trigger; 92% by the second trigger. Of the 62 triggered visits that did not result in an immediate conversation, clinicians identified the following reasons: 26% not enough time; 20% clinician attitudes about the impact and timing of such conversations (i.e., they take away hope, patient not sick enough); 46% immediate patient issues making conversation inappropriate (i.e., patient acutely ill, anxious, depressed, or not ready); and 8% “other.” Conclusions: An email trigger in the outpatient oncology clinic is highly effective in promoting ACP conversations for trained clinicians. The majority of clinician-identified barriers to such discussions reflect beliefs about the impact and timing of the discussion and concerns about the patient’s immediate condition; time constraints only account for about a quarter of delays. Clinical trial information: NCT01786811.

scholarly journals Advance Care Planning and Advance Directives Completion of Elderly Patients at a Rural Health Clinic on a Regional Medical Campus

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Sarah Irvin ◽  
Melissa McGowan ◽  
Adrienne Zavala
Keyword(s):  
Rural Health ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Living Will ◽  
Health Clinic ◽  
Care Planning ◽  
Power Of Attorney ◽  
Advanced Directives ◽  
Number Of Patients ◽  
Advance Care

Advance care planning is the shared decision-making process between physicians, patients, and families regarding the patient’s preferences for end of life care. These conversations increase compliance with patient wishes, decrease hospitalizations, increase deaths in patient’s preferred location, and decrease depression in surviving family members3. Even though there is proven benefit from advance care planning, these discussions are often overlooked. The purpose of this study is to evaluate rates of advance care planning and advance directive completion rate of 245 geriatric patients at our rural health clinic training site. We searched the electronic medical record to determine the number of patients who were asked about advance directives, stated they had a living will or medical power of attorney (MPOA), and had a living will or MPOA scanned into their chart. Out of the study population, 45% of patients stated they had some form of advanced directives. Of these patients, 22% and 25% had a living will and MPOA scanned into their chart, respectively. This study demonstrates the need for detailed discussion about advanced care planning with patients and additional follow-up to ensure documentation is readily available.  

scholarly journals Understanding Underuse of Advance Care Planning Among a Cohort of African American Patients With Advanced Cancer: Formative Research That Examines Gaps in Intent to Discuss Options for Care

2019 ◽  
Vol 36 (12) ◽  
pp. 1057-1062 ◽  
Author(s):  
Ramona L. Rhodes ◽  
Nkemdirim C. E. Ukoha ◽  
Kimberly A. Williams ◽  
Bryan Elwood ◽  
Tori Knox-Rice ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Advance Care Planning ◽  
Transtheoretical Model ◽  
Safety Net ◽  
Living Will ◽  
Formative Research ◽  
Care Planning ◽  
Safety Net Hospital ◽  
Advance Care ◽  
The Impact

Background: Advance care planning (ACP), palliative care (PC), and hospice are often underutilized by African Americans (AAs). This study assessed the impact of stage of intent to discuss ACP options as key potential barriers. Methods: We examined intent to discuss completion of ACP, PC, and hospice among 22 AA patients with cancer admitted to a local safety net hospital. Participants were asked about intent to discuss an advanced directive or living will (AD/LW), medical power of attorney (MPOA), PC, and hospice with their doctors. Intent to discuss these ACP components was based on the transtheoretical model. Electronic health records were reviewed at various intervals to assess completion of ACP behaviors and survival. Results: Participants had colorectal (33%), breast (44%), and lung (23%) cancer, and 82% had stage III/IV disease. Low percentages of patients were in the precontemplation stage for AD/LW completion (4.6%), MPOA completion (13.6%), and PC discussions (27.2%), but 77.2% were in the precontemplation stage for hospice discussions. At 1 year, only 5% completed an AD/LW, 36.4% appointed an MPOA, 42.9% were referred to PC, and 12.5% were referred to hospice. More than half (54.6%) were deceased by the study’s conclusion. Most (81%) of these died within 6 months of their baseline study assessment. Conclusions: Despite being hospitalized with advanced cancer and having poor prognosis, intent to discuss ACP options, PC, and hospice in this population was variable, and completion of these activities was low. This formative research is needed to develop education and counseling interventions for this high-risk, vulnerable population.

Patient and caregiver characteristics related to completion of advance directives in terminally ill patients

2016 ◽  
Vol 15 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Grace W.K. Ho ◽  
Lauren Skaggs ◽  
Gayane Yenokyan ◽  
Anela Kellogg ◽  
Julie A. Johnson ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Terminal Illness ◽  
Terminally Ill ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Convenience Sample ◽  
Advance Care ◽  
Lateral Sclerosis

AbstractObjective:There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney.Method:A convenience sample of 206 caregiver–patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion.Results:Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place.Significance of results:Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.

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.

scholarly journals The Impact of Varying Levels of Advance Care Planning Engagement on Perceptions of the End-of-Life Experience Among Caregivers of Deceased Patients With Cancer

2020 ◽  
Vol 37 (12) ◽  
pp. 1045-1052 ◽  
Author(s):  
Kristin Levoy ◽  
Harleah Buck ◽  
Victoria Behar-Zusman
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Structural Equation ◽  
Life Experiences ◽  
Living Will ◽  
Equation Modeling ◽  
Care Planning ◽  
Patients With Cancer ◽  
Advance Care ◽  
The Impact

Context: Advance care planning (ACP) is used to prepare patients and caregivers for future “in the moment” decisions at the end-of-life. Patients with cancer generally do not engage in all 3 components of ACP (documented living will, health-care surrogate, end-of-life discussions); however, little is known about the impact of these varying levels of ACP engagement on caregivers postdeath. Objective: To examine the relationship between varying levels of ACP engagement and caregivers’ perceptions of cancer decedents’ end-of-life experiences. Methods: A secondary analysis of the 2002 to 2014 waves of the Health and Retirement Study data using structural equation modeling was conducted. Five levels of ACP engagement were defined: full (discussions/documents), augmented discussions, documents only, discussions only, and no engagement. Results: Among the 2172 cancer death cases, the analyzed sample included 983 cases where end-of-life decisions occurred. Compared to no ACP, all levels of ACP were significantly associated with caregivers’ positive perceptions of cancer decedents’ end-of-life experiences ( P ≤ .001), controlling for sex, race, and Hispanic ethnicity ( R 2 = .21). However, the relative impact of each level of ACP engagement was not equal; full engagement (β = .61) was associated with a greater impact compared to each of the partial levels of engagement (augmented discussions [β = .33], documents only [β = .17], discussions only [β = .17]). Conclusion: Partial ACP engagement, not just nonengagement, serves as an important clinically modifiable target to improve the end-of-life care experience among patients with cancer and the perceptions of those experiences among bereaved caregivers.

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.

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