Advance Care Planning Gaining Steam Among Minority Populations

While racial and socioeconomic disparities persist throughout the health care system, things are changing in the realm of advance care planning. A new study in the Journal of the American Medical Association Open has found that African American and Hispanic patients outpaced Caucasians in advance care planning utilization between the Fall 2019 and Summer 2021, a trend largely spurred by the pandemic.

Researchers offered a series of videos that explored advance care planning decisions to more than 14,000 patients in a large health system in New York state, including a network of ambulatory care centers.

Following these interventions, utilization among African American patients rose to 30%, up from 18% pre-COVID. Researchers observed a similar trend among Hispanics. Utilization hit 21%, compared with 13% before the pandemic.

This positive trend emerged in tandem with the sobering reality that COVID-19 has disproportionately affected people of color.

“If you’re African American or you’re Hispanic and you’re going to see your doctor during this period of time, having these discussions is not hypothetical. You’re thinking about the people in church that are no longer there, because it disproportionately hit your community,” Angelo Volandes, physician and researcher at Harvard Medical School and Massachusetts General Hospital, told Hospice News. “When you ask someone from an African American community how many people do you know that have passed from COVID, the numbers are just dramatic.”

Volandes is also the founder of the non-profit ACP Decisions, which developed a shared-decision making platform to support advance care planning.

As of Oct. 2021 when the nation’s COVID death toll reached 800,000 people, 77% of the deceased were in the 65 years or older age group and 33% were African American or Hispanic, according to the U.S. Centers for Disease Control & Prevention.

Variations exist in the ways health care providers conduct advance care planning. The two essential elements are a discussion about your goals of care and wishes for end-of-life as well as designation of a surrogate decision maker in the event that you become incapacitated.

Prior research demonstrated that video decision aids and clinician communication skills training have both shown promise in fostering wider acceptance of advance care planning, but found that scaling these interventions was difficult, according to references cited in the JAMA paper.

Projects that focused on each of those methods individually had “suboptimal” results, but the widespread adoption of telehealth and remote communication technology during the pandemic gave providers an opening to combine the two methods, according to the study.

Volandes told Hospice News that the new data represent an opportunity for health care providers to make advance care planning and goals-of-care conversations a higher priority.

“We need to take advanced care planning as seriously as we do getting a patient’s medication lists for taking a patient’s allergies,” Volandes said. “I think it should be part of the standard workflow for all patients, but especially patients over the age of 65 and patients with comorbidities. We also really need to think about those who are the least empowered in our health care system.”