TY - JOUR
T1 - Understanding Underuse of Advance Care Planning Among a Cohort of African American Patients With Advanced Cancer
T2 - Formative Research That Examines Gaps in Intent to Discuss Options for Care
AU - Rhodes, Ramona L.
AU - Ukoha, Nkemdirim C.E.
AU - Williams, Kimberly A.
AU - Elwood, Bryan
AU - Knox-Rice, Tori
AU - Lee, Simon C.
AU - Tiro, Jasmin A.
AU - Skinner, Celette Sugg
AU - Halm, Ethan A.
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was conducted as part of the Center for Patient-Centered Outcomes Research with support from AHRQ Grant R24 HS022418. This project was also supported by the Palliative Care Research Cooperative Group funded by the National Institute of Nursing Research U24NR014637. Drs. Halm, Skinner, Tiro, and Lee received support from the Simmons Cancer Center (NCI P30 CA142543). Ms. Ukoha received support from Grant T35AG038048 from the National Institute on Aging and the Geriatric Research and Training Fund at the University of Texas Southwestern Medical School. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, NIH, or other funding agencies. The funding agencies had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, and approval of the manuscript.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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.
AB - 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.
KW - African Americans
KW - advance care planning
KW - advanced cancer
KW - hospice
KW - palliative care
KW - safety net
UR - http://www.scopus.com/inward/record.url?scp=85064817966&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064817966&partnerID=8YFLogxK
U2 - 10.1177/1049909119843276
DO - 10.1177/1049909119843276
M3 - Article
C2 - 31006248
AN - SCOPUS:85064817966
SN - 1049-9091
VL - 36
SP - 1057
EP - 1062
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
IS - 12
ER -