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Engagement in Multiple Steps of the Advance Care Planning Process: A Descriptive Study of Diverse Older Adults.

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Title: Engagement in Multiple Steps of the Advance Care Planning Process: A Descriptive Study of Diverse Older Adults.
Authors: Sudore, Rebecca L., Schickedanz, Adam D., Landefeld, C. Seth, Williams, Brie A., Lindquist, Karla, Pantilat, Steven Z., Schillinger, Dean
Source: Journal of the American Geriatrics Society. Jun2008, Vol. 56 Issue 6, p1006-1013. 8p. 1 Diagram, 3 Charts, 1 Graph.
Subjects: Medical care, Elder care, Health of older people, Spanish Americans, Decision making, Ethnicity
Abstract: OBJECTIVES: To assess engagement in multiple steps of the advance care planning (ACP) process 6 months after exposure to an advance directive. In this study, ACP is conceptualized similarly to the behavior change model. DESIGN: Descriptive study. SETTINGS: County general medicine clinic in San Francisco. PARTICIPANTS: One hundred seventy-three English or Spanish speakers, aged 50 and older (mean 61) given a standard (12th-grade reading level) and an easy-to-read (5th-grade reading level) advance directive. MEASUREMENTS: Six months after exposure to two advance directives, self-reported ACP contemplation; discussions with family, friends discussions with clinicians; and documentation were measured. Associations were examined between ACP steps and between subject characteristics ACP engagement. RESULTS: Most participants (73%) were nonwhite and 31% had less than a high school education. Sixty-one percent contemplated ACP, 56% discussed ACP with family or friends, 22% discussed ACP with clinicians, and 13% documented ACP wishes. Subjects who had discussed ACP with their family or friends were more likely to discuss ACP with their clinicians (36% vs 2%, P<.001) and document ACP wishes (18% vs 4%, P=.009) than those who had not. Latinos and subjects with less than a high school education discussed ACP more often with family or friends ( P<.06) and clinicians ( P<.03) than other ethnic groups and subjects with more education. CONCLUSIONS: ACP involves distinct steps including contemplation, discussions, and documentation. The ACP paradigm should be broadened to include contemplation and discussions. Promoting discussions with family and friends may be one of the most important targets for ACP interventions, and literacy- and language-appropriate advance directives may help reverse patterns of sociodemographic disparities in ACP. [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
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  Data: OBJECTIVES: To assess engagement in multiple steps of the advance care planning (ACP) process 6 months after exposure to an advance directive. In this study, ACP is conceptualized similarly to the behavior change model. DESIGN: Descriptive study. SETTINGS: County general medicine clinic in San Francisco. PARTICIPANTS: One hundred seventy-three English or Spanish speakers, aged 50 and older (mean 61) given a standard (12th-grade reading level) and an easy-to-read (5th-grade reading level) advance directive. MEASUREMENTS: Six months after exposure to two advance directives, self-reported ACP contemplation; discussions with family, friends discussions with clinicians; and documentation were measured. Associations were examined between ACP steps and between subject characteristics ACP engagement. RESULTS: Most participants (73%) were nonwhite and 31% had less than a high school education. Sixty-one percent contemplated ACP, 56% discussed ACP with family or friends, 22% discussed ACP with clinicians, and 13% documented ACP wishes. Subjects who had discussed ACP with their family or friends were more likely to discuss ACP with their clinicians (36% vs 2%, P&lt;.001) and document ACP wishes (18% vs 4%, P=.009) than those who had not. Latinos and subjects with less than a high school education discussed ACP more often with family or friends ( P&lt;.06) and clinicians ( P&lt;.03) than other ethnic groups and subjects with more education. CONCLUSIONS: ACP involves distinct steps including contemplation, discussions, and documentation. The ACP paradigm should be broadened to include contemplation and discussions. Promoting discussions with family and friends may be one of the most important targets for ACP interventions, and literacy- and language-appropriate advance directives may help reverse patterns of sociodemographic disparities in ACP. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;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&#39;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.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1111/j.1532-5415.2008.01701.x
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      – SubjectFull: Elder care
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      – SubjectFull: Health of older people
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      – SubjectFull: Spanish Americans
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              Text: Jun2008
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