Document Detail


Advance directive discussions: lost in translation or lost opportunities?
MedLine Citation:
PMID:  22239609     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Previous studies have shown that minority populations have low rates of documented advance directives and express preferences for more life-prolonging interventions at the end of life. We sought to determine the impact of Latino ethnicity on patients' self-report of having an advance directive discussion and having a completed advance directive in the medical record at an index hospitalization for serious medical illness.
METHODS: This was a prospective observational cohort study of 458 adults admitted to the general medical services of a safety net hospital, an academic medical center, and a Veterans' Affairs (VA) hospital. Patients were asked if they had discussed advance directives, and we reviewed medical records for documented advance directives.
RESULTS: Overall, 45% of patients reported having had a discussion about advance directives (29% of Latinos compared with 54% of Caucasians, p=0.0002) and 24% of patients had a completed advance directive in their medical record (25% Latinos and 26% of Caucasians, p=not significant [ns]). Using logistic regression modeling and adjusting for socioeconomic status (SES), education level, and language spoken, Latinos (odds ratio [OR] 0.42, confidence interval [CI] 0.24-0.75) were less likely to report having advance directive discussions compared with Caucasians (referent). However, modeling of a completed advance directive in the medical record showed no significant difference between Latinos (OR 1.44, CI 0.73-2.85) and Caucasians (referent).
CONCLUSIONS: The unexpected discrepancy we found highlights the need for more effective communication in advance care planning that includes education that is culturally sensitive and accessible to persons with low health literacy.
Authors:
Stacy M Fischer; Angela Sauaia; Sung-Joon Min; Jean Kutner
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-01-12
Journal Detail:
Title:  Journal of palliative medicine     Volume:  15     ISSN:  1557-7740     ISO Abbreviation:  J Palliat Med     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-24     Completed Date:  2012-06-06     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  9808462     Medline TA:  J Palliat Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  86-92     Citation Subset:  IM    
Affiliation:
Division of Health Care Policy and Research, University of Colorado Denver School of Medicine, Aurora, Colorado 80045-7201, USA. stacy.fischer@ucdenver.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Advance Care Planning*
Advance Directives / ethnology*
Aged
Colorado
Female
Hospitals, University
Hospitals, Veterans
Humans
Interviews as Topic
Logistic Models
Male
Middle Aged
Minority Groups
Prospective Studies
Grant Support
ID/Acronym/Agency:
K23 AG028957-02/AG/NIA NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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