Wellness in Sickness and Health (The W.I.S.H. Project): Advance Care Planning Preferences and Experiences Among Elderly Latino Patients

• Published in: Clinical gerontologist 2019-05, Vol.42 (3), p.259-266
• Main Authors: Maldonado, Lauren Y, Goodson, Ruth B, Mulroy, Matthew C, Johnson, Emily M, Reilly, Jo M, Homeier, Diana C
• Format: Article
• Language: English
• Subjects: Advance directives; Advance health care directive; Care plans; Chronic illnesses; Comfort; Counseling; Cultural competence; elderly; End of life decisions; Geriatrics; Health status; Hispanic/Latino; Latin American cultural groups; Medical conditions; medicine; Older people; palliative care; Patient communication; Patients; Polls & surveys; Primary care; Relatives
• ISSN: 0731-7115; 1545-2301
• DOI: 10.1080/07317115.2017.1389793

Objective: To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos. Methods: Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey. Results: Patients were primarily Spanish speaking with an average of 2.7 chronic medical conditions. Most had not previously documented (95%) or discussed (76%) EOL wishes. Most were unaware they had control over their EOL treatment (61%), but valued learning about EOL options (83%). Post-counseling, 85% reported comfort discussing EOL goals compared to 66% pre-session, and 88% elected to complete an AD. Nearly half of patients reported a desire to discuss EOL wishes sooner. Conclusions: Elderly Latino patients are interested in ACP, given individualized, culturally competent counseling in their preferred language. Clinical Implications: Patients should be offered the opportunity to discuss and document EOL wishes at all primary care appointments, regardless of health status. Counseling should be completed in the patient's preferred language, using culturally competent materials, and with family members present if this is the patient's preference. Cultural-competency training for providers could enhance the impact of EOL discussions and improve ACP completion rates for Latino patients.