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A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South.
J Palliat Med. 2016 Feb; 19(2):164-73.JP

Abstract

BACKGROUND

Despite growing efforts to facilitate advance care planning (ACP) to decrease health disparities in palliative care, low completion rates of advance directives (AD) have been consistently found among African Americans.

OBJECTIVE

The objective was to examine the feasibility of a multicomponent ACP intervention program that integrates motivational interviewing, evidence-based ACP facilitation program (Respecting Choices(®)), and health-literacy adjusted AD. This pilot study aims to address the unique barriers to ACP engagement among African Americans in the Deep South.

METHODS

The design was a mixed-method randomized controlled trial design. Analysis of covariance (ANCOVA) and thematic content analysis (TCA) were conducted to identify barriers and facilitators for ACP engagement and to assess feasibility, knowledge, and intention to complete an AD. Thirty community-dwelling African Americans (mean age M = 55.43, SD = 6.71, range = 47-73) were recruited from the Deep South and randomly assigned to receive intervention (n = 15) or educational material (n = 15) at a local university medical center.

RESULTS

All participants (n = 30) reported high satisfaction (M = 4.81, SD = 0.44, max score = 5) and increased intent to complete an AD at postintervention. A significant increase in knowledge on AD from baseline to postintervention was observed in the intervention group-t(14) = -3.06, p = 0.01, d = 1.67); no significant change was found for control. Lack of information, mistrust of doctors, and avoidance of discussing death were primary barriers to ACP discussions. Facilitators include ACP education, decreased mistrust, and proactive initiation of ongoing ACP discussions.

CONCLUSIONS

Feasibility data revealed successful implementation of a brief intervention to increase ACP engagement and willingness to complete an AD among southern African Americans.

Authors+Show Affiliations

1 Center for Palliative and Supportive Care, Department of Medicine, University of Alabama , Birmingham, Alabama. 2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama.2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama. 3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama. 3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.4 Center for the Advanced Study of Teaching and Learning, University of Virginia , Charlottesville, Virginia.2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama. 3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.1 Center for Palliative and Supportive Care, Department of Medicine, University of Alabama , Birmingham, Alabama. 2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama. 3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama. 6 Birmingham VA Medical Center , Birmingham, Alabama.3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama. 5 Department of Psychiatry and Behavioral Sciences, East Virginia Medical School , Nortolk, Virginia.1 Center for Palliative and Supportive Care, Department of Medicine, University of Alabama , Birmingham, Alabama. 6 Birmingham VA Medical Center , Birmingham, Alabama.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26840852

Citation

Huang, Chao-Hui Sylvia, et al. "A Pilot Feasibility Intervention to Increase Advance Care Planning Among African Americans in the Deep South." Journal of Palliative Medicine, vol. 19, no. 2, 2016, pp. 164-73.
Huang CH, Crowther M, Allen RS, et al. A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South. J Palliat Med. 2016;19(2):164-73.
Huang, C. H., Crowther, M., Allen, R. S., DeCoster, J., Kim, G., Azuero, C., Ang, X., & Kvale, E. (2016). A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South. Journal of Palliative Medicine, 19(2), 164-73. https://doi.org/10.1089/jpm.2015.0334
Huang CH, et al. A Pilot Feasibility Intervention to Increase Advance Care Planning Among African Americans in the Deep South. J Palliat Med. 2016;19(2):164-73. PubMed PMID: 26840852.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South. AU - Huang,Chao-Hui Sylvia, AU - Crowther,Martha, AU - Allen,Rebecca S, AU - DeCoster,Jamie, AU - Kim,Giyeon, AU - Azuero,Casey, AU - Ang,Xinying, AU - Kvale,Elizabeth, PY - 2016/2/4/entrez PY - 2016/2/4/pubmed PY - 2016/12/15/medline SP - 164 EP - 73 JF - Journal of palliative medicine JO - J Palliat Med VL - 19 IS - 2 N2 - BACKGROUND: Despite growing efforts to facilitate advance care planning (ACP) to decrease health disparities in palliative care, low completion rates of advance directives (AD) have been consistently found among African Americans. OBJECTIVE: The objective was to examine the feasibility of a multicomponent ACP intervention program that integrates motivational interviewing, evidence-based ACP facilitation program (Respecting Choices(®)), and health-literacy adjusted AD. This pilot study aims to address the unique barriers to ACP engagement among African Americans in the Deep South. METHODS: The design was a mixed-method randomized controlled trial design. Analysis of covariance (ANCOVA) and thematic content analysis (TCA) were conducted to identify barriers and facilitators for ACP engagement and to assess feasibility, knowledge, and intention to complete an AD. Thirty community-dwelling African Americans (mean age M = 55.43, SD = 6.71, range = 47-73) were recruited from the Deep South and randomly assigned to receive intervention (n = 15) or educational material (n = 15) at a local university medical center. RESULTS: All participants (n = 30) reported high satisfaction (M = 4.81, SD = 0.44, max score = 5) and increased intent to complete an AD at postintervention. A significant increase in knowledge on AD from baseline to postintervention was observed in the intervention group-t(14) = -3.06, p = 0.01, d = 1.67); no significant change was found for control. Lack of information, mistrust of doctors, and avoidance of discussing death were primary barriers to ACP discussions. Facilitators include ACP education, decreased mistrust, and proactive initiation of ongoing ACP discussions. CONCLUSIONS: Feasibility data revealed successful implementation of a brief intervention to increase ACP engagement and willingness to complete an AD among southern African Americans. SN - 1557-7740 UR - https://www.unboundmedicine.com/medline/citation/26840852/A_Pilot_Feasibility_Intervention_to_Increase_Advance_Care_Planning_among_African_Americans_in_the_Deep_South_ L2 - https://www.liebertpub.com/doi/full/10.1089/jpm.2015.0334?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -