English- and Spanish-Speaking Vulnerable Older Adults Report Many Unique Barriers to Advance Care Planning (W215A)

• Published in: Journal of pain and symptom management 2021-03, Vol.61 (3), p.641-642
• Main Authors: Phung, Linda H., Barnes, Deborah E., Volow, Aiesha M., Shirsat, Nikita R., Sudore, Rebecca L.
• Format: Article
• Language: English
• Subjects: Advance directives; Barriers; Care plans; Chart reviews; Content analysis; Demography; Discomfort; Documentation; Ethnic groups; Friendship; God; Health education; Health literacy; Hospitals; Minority & ethnic groups; Minority groups; Older people; Vulnerability
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2021.01.015

Objectives 1. Identify common barriers to advance care planning for diverse English- and Spanish-speaking older adults. 2. Recognize which vulnerable subpopulations report the most barriers to advance care planning. 3. Recognize that barriers to advance care planning are associated with lower rates of ACP documentation (e.g. advance directive, POLST). Original Research Background Advance care planning (ACP) rates are low in diverse, vulnerable older adults, yet little is known about the unique barriers they face and how these barriers impact ACP documentation rates. Research Objectives To describe patient-reported barriers to ACP among older adults and the association between barriers and ACP documentation. Methods We used baseline data from 1241 English and Spanish-speaking patients enrolled in two trials at two safety-net San Francisco hospitals. We used validated questionnaires to ask participants about ACP barriers using a list of patient, family/friend, and clinician/system-level barriers and an open-ended question, analyzed using content analysis. We conducted chart review for prior ACP documentation. We used Chi-square/Wilcoxon rank-sum tests and linear/logistic regression to assess associations between ACP barriers and demographic characteristics/ACP documentation. Results Participant mean age was 65+7.4 years; they were 74% racial/ethnic minority groups, 36% Spanish-speaking, and 36% with limited health literacy. 26 barriers were identified (15 patient, 4 family/friend, 7 clinician/system-level), and 91% reported ≥1 ACP barrier (mean: 5.6±4.0). The most common barriers were: (patient-level) discomfort thinking about ACP (60%), wanting to leave health decisions to "God" (44%); (family/friend-level) not wanting to burden friends/family (33%), assuming friends/family already knew their preferences (31%); (clinician/system-level) assuming doctors already knew their preferences (41%) and mistrust (37%). ACP barriers were more common among racial/ethnic minorities vs. non-minorities (76% vs. 53%), Spanish- vs. English-speakers (39% vs. 6%), and those with fair-to-poor vs. good-to-excellent health (48% vs. 34%) or limited vs. adequate health literacy (39% vs. 9%) (p