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.
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.
Authors: N S Wenger; D E Kanouse; R L Collins; H Liu; M A Schuster; A L Gifford; S A Bozzette; M F Shapiro Journal: JAMA Date: 2001-06-13 Impact factor: 56.272
Authors: Carolyn E Schwartz; H Brownell Wheeler; Bernard Hammes; Noreen Basque; Jean Edmunds; George Reed; Yunsheng Ma; Lynn Li; Patricia Tabloski; Julianne Yanko Journal: Arch Intern Med Date: 2002-07-22
Authors: Rebecca L Sudore; Daren K Heyland; Deborah E Barnes; Michelle Howard; Konrad Fassbender; Carole A Robinson; John Boscardin; John J You Journal: J Pain Symptom Manage Date: 2016-12-29 Impact factor: 3.612
Authors: Hillary D Lum; Rebecca L Sudore; Daniel D Matlock; Elizabeth Juarez-Colunga; Jacqueline Jones; Molly Nowels; Robert S Schwartz; Jean S Kutner; Cari R Levy Journal: J Am Board Fam Med Date: 2017 Jul-Aug Impact factor: 2.657
Authors: Adam D Schickedanz; Dean Schillinger; C Seth Landefeld; Sara J Knight; Brie A Williams; Rebecca L Sudore Journal: J Am Geriatr Soc Date: 2009-01 Impact factor: 5.562
Authors: Natasha Michael; Clare O'Callaghan; Josephine Clayton; Annabel Pollard; Nikola Stepanov; Odette Spruyt; Michael Michael; David Ball Journal: Support Care Cancer Date: 2013-03-14 Impact factor: 3.603
Authors: Hillary D Lum; Jacqueline Jones; Daniel D Matlock; Russell E Glasgow; Ingrid Lobo; Cari R Levy; Robert S Schwartz; Rebecca L Sudore; Jean S Kutner Journal: Ann Fam Med Date: 2016-03 Impact factor: 5.166