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Factors related to advance care planning among older African American women: Age, medication, and acute care visits

Published online by Cambridge University Press:  27 November 2019

Jung Kwak Open the ORCID record for Jung Kwak [Opens in a new window]  and
Julie L. Ellis
Jung Kwak*
Affiliation:
School of Nursing, The University of Texas at Austin, Austin, TX
Julie L. Ellis
Affiliation:
College of Nursing, University of Wisconsin Milwaukee, Milwaukee, WI
*
Author for correspondence: Jung Kwak, School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX78701, USA. E-mail: jkwak@nursing.utexas.edu
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Abstract

Objectives

Advance care planning (ACP) is linked with high-quality clinical outcomes at the end of life. However, ACP engagement is lower among African Americans than among Whites. In this study, we sought to identify correlates of ACP among African American women with multiple chronic conditions for two reasons: (1) African American women with multiple chronic conditions have high risks for serious illnesses, more intensive treatments, and circumstances that may require substitutes' decision-making and (2) identifying correlates of ACP among African American women can help us identify important characteristics to inform ACP outreach and interventions for this group.

Methods

A cross-sectional survey was conducted with 116 African American women aged ≥50 years who were recruited from the central area of a mid-western city.

Results

On average, participants were 64 years old (SD = 9.42). The majority were not married (78%), had less than a college education (50%), and had an annual income of $15,000 (54%). Their mean numbers of chronic conditions and prescribed medications were 3.31 (SD = 1.25) and 8.75 (SD = 4.42), respectively. Fifty-nine per cent reported having talked with someone about their preferences (informal ACP); only 30% had completed a living will or a power of attorney for healthcare (formal ACP). Logistic regression showed that age, the number of hospitalizations or emergency department visits, and the number of prescription medications were significantly correlated with both informal and formal ACP; other demographic and psychosocial characteristics (the knowledge of ACP, self-efficacy, and trust in the medical system) were not.

Significance of results

Results of this study suggest a need for targeted, culturally sensitive outpatient ACP education to promote ACP engagement in older African American women, taking into account age, the severity of chronic conditions, and levels of medication management.

Keywords

Advance care planningAfrican AmericanChronic conditionsEnd of life
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Special Issue 4: Palliative and Supportive Care During The COVID-19 Pandemic , August 2020 , pp. 413 - 418
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Copyright
Copyright © Cambridge University Press 2019

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