View in EDS

Disparities in Advance Care Planning: Did COVID‐19 Change Anything?

Saved in:
Bibliographic Details
Title: Disparities in Advance Care Planning: Did COVID‐19 Change Anything?
Authors: Gangavati, Anupama, Johnson, Kimberly S., Platt, Alyssa, Olsen, Maren, Durant, Raegan W., Ejem, Deborah, Bakitas, Marie, Dolor, Rowena, Williams‐Bryant, Sherone N., Barrett, Nadine, Elk, Ronit, Quest, Tammie, Hasan, Marisette, Bethea, Kenisha, Rhodes, Ramona
Source: Journal of the American Geriatrics Society. Jun2026, Vol. 74 Issue 6, p1722-1728. 7p.
Subjects: Elder care, Cross-sectional method, African Americans, Research funding, Hispanic Americans, Fisher exact test, Logistic regression analysis, Descriptive statistics, Chi-squared test, Mann Whitney U Test, Multivariate analysis, Race, Family attitudes, Odds ratio, Health equity, Confidence intervals, Data analysis software, Advance directives (Medical care), COVID-19 pandemic, COVID-19
Abstract: Background: Rates of advance care planning (ACP) are lower and preferences for life‐prolonging treatment are higher among Black compared to White older adults. We examined whether these differences persisted during the COVID‐19 pandemic. Methods: Between February 2021 and September 2022, we conducted a cross‐sectional COVID‐19–focused survey of seriously ill adults ≥ 65 years in 10 primary care clinics participating in a clinical trial of two ACP interventions. Logistic regression models examined associations between COVID‐19 related ACP discussion (defined as discussions with family, friends, or doctors about COVID‐related medical care) and treatment preferences if very sick with COVID‐19 (life‐prolonging treatment, comfort care, trial of life‐prolonging with transition to comfort care if no improvement) overall and by race, controlling for baseline characteristics. Results: Among 428 participants (55.9% Black, 44.2% White; mean age 74.6), 25% reported discussing COVID‐19 treatment preferences with family/friends and 6% with doctors. Most reported no change in willingness to participate in ACP due to the pandemic, though increased willingness was more common among Black than White participants (22.4% vs. 14.0%, p = 0.016). Despite this, COVID‐19‐related ACP discussion did not differ by race (family/friends: 22.7% vs. 28.3%, p = 0.19; doctors: 6.9% vs. 4.8%, p = 0.37). Most seriously ill older adults preferred a time‐limited trial of life‐prolonging treatment (71% White, 56.2% Black); though preferences varied by race (p < 0.0001); Black participants compared to White participants more often preferred life‐prolonging treatment (28.5% vs. 10.3%). In adjusted models, race was not associated with COVID‐19‐related ACP discussion (OR 0.72, 95% CI 0.44–1.18), while preferences for life‐prolonging treatments predicted greater COVID‐19 related ACP discussion (OR 1.98, 95% CI 1.14–3.44). Conclusion: In contrast to pre‐pandemic ACP research, no racial differences were observed in COVID‐19‐related ACP discussion, though differences in treatment preferences persisted. These findings underscore the need for culturally responsive, context‐sensitive ACP approaches among seriously ill older adults. Summary: Key points ○In this study of 428 seriously ill Black and White older adults, only 25% talked to family or friends, and 6% talked to healthcare providers about the type of care they would want if they became sick with COVID‐19. Rates of COVID‐19‐related advance care planning discussions were similar among seriously ill Black and White older adults.○Among these seriously ill older adults, most preferred a trial of life‐prolonging treatments with a transition to comfort care if no improvement if they became very sick with COVID‐19 (71% of White older adults and 56% of Black older adults). Preferences for all treatments to stay alive as long as possible if very sick with COVID‐19 were expressed by a small proportion of seriously ill older adults and were more common among Black older adults (28.5% vs. 10.3%).○Seriously ill older adults who wanted all treatments to stay alive as long as possible (vs. comfort‐focused care or trial of life‐prolonging therapies with a change to comfort care if no improvement) were more likely to have talked to family, friends, or doctors about their treatment preferences if they became very sick with COVID‐19.Why this paper matters? ○Most studies have found lower rates of advance care planning (ACP) among Black compared to White seriously ill older adults. In this study, however, rates of COVID‐related ACP discussions were similar among seriously ill Black and White older adults. Preferences for care if very sick with COVID‐19, however, varied by race. Although most older adults preferred a time‐limited trial of life‐prolonging treatment, Black older adults were more likely than White older adults to prefer all life‐prolonging treatments. These findings suggest that even when rates of ACP‐related discussions are similar, racial differences in preferences for care persist among seriously ill older adults. These findings highlight the need for interventions that both promote ACP discussion outside of crisis contexts and honor the cultural values that shape end‐of‐life care preferences. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
Description
Abstract:Background: Rates of advance care planning (ACP) are lower and preferences for life‐prolonging treatment are higher among Black compared to White older adults. We examined whether these differences persisted during the COVID‐19 pandemic. Methods: Between February 2021 and September 2022, we conducted a cross‐sectional COVID‐19–focused survey of seriously ill adults ≥ 65 years in 10 primary care clinics participating in a clinical trial of two ACP interventions. Logistic regression models examined associations between COVID‐19 related ACP discussion (defined as discussions with family, friends, or doctors about COVID‐related medical care) and treatment preferences if very sick with COVID‐19 (life‐prolonging treatment, comfort care, trial of life‐prolonging with transition to comfort care if no improvement) overall and by race, controlling for baseline characteristics. Results: Among 428 participants (55.9% Black, 44.2% White; mean age 74.6), 25% reported discussing COVID‐19 treatment preferences with family/friends and 6% with doctors. Most reported no change in willingness to participate in ACP due to the pandemic, though increased willingness was more common among Black than White participants (22.4% vs. 14.0%, p = 0.016). Despite this, COVID‐19‐related ACP discussion did not differ by race (family/friends: 22.7% vs. 28.3%, p = 0.19; doctors: 6.9% vs. 4.8%, p = 0.37). Most seriously ill older adults preferred a time‐limited trial of life‐prolonging treatment (71% White, 56.2% Black); though preferences varied by race (p < 0.0001); Black participants compared to White participants more often preferred life‐prolonging treatment (28.5% vs. 10.3%). In adjusted models, race was not associated with COVID‐19‐related ACP discussion (OR 0.72, 95% CI 0.44–1.18), while preferences for life‐prolonging treatments predicted greater COVID‐19 related ACP discussion (OR 1.98, 95% CI 1.14–3.44). Conclusion: In contrast to pre‐pandemic ACP research, no racial differences were observed in COVID‐19‐related ACP discussion, though differences in treatment preferences persisted. These findings underscore the need for culturally responsive, context‐sensitive ACP approaches among seriously ill older adults. Summary: Key points ○In this study of 428 seriously ill Black and White older adults, only 25% talked to family or friends, and 6% talked to healthcare providers about the type of care they would want if they became sick with COVID‐19. Rates of COVID‐19‐related advance care planning discussions were similar among seriously ill Black and White older adults.○Among these seriously ill older adults, most preferred a trial of life‐prolonging treatments with a transition to comfort care if no improvement if they became very sick with COVID‐19 (71% of White older adults and 56% of Black older adults). Preferences for all treatments to stay alive as long as possible if very sick with COVID‐19 were expressed by a small proportion of seriously ill older adults and were more common among Black older adults (28.5% vs. 10.3%).○Seriously ill older adults who wanted all treatments to stay alive as long as possible (vs. comfort‐focused care or trial of life‐prolonging therapies with a change to comfort care if no improvement) were more likely to have talked to family, friends, or doctors about their treatment preferences if they became very sick with COVID‐19.Why this paper matters? ○Most studies have found lower rates of advance care planning (ACP) among Black compared to White seriously ill older adults. In this study, however, rates of COVID‐related ACP discussions were similar among seriously ill Black and White older adults. Preferences for care if very sick with COVID‐19, however, varied by race. Although most older adults preferred a time‐limited trial of life‐prolonging treatment, Black older adults were more likely than White older adults to prefer all life‐prolonging treatments. These findings suggest that even when rates of ACP‐related discussions are similar, racial differences in preferences for care persist among seriously ill older adults. These findings highlight the need for interventions that both promote ACP discussion outside of crisis contexts and honor the cultural values that shape end‐of‐life care preferences. [ABSTRACT FROM AUTHOR]
ISSN:00028614
DOI:10.1111/jgs.70509