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Lenko RA, Hoffman GJ, Robinson-Lane SG, Silveira MJ, Voepel-Lewis T. Achieving goal-concordant care: Formal and informal advance care planning for White, Black, and Hispanic older adults. J Am Geriatr Soc 2024. [PMID: 38760957 DOI: 10.1111/jgs.18971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Advance care planning (ACP) aims to ensure that patients receive goal-concordant care (GCC), which is especially important for racially or ethnically minoritized populations at greater risk of poor end-of-life outcomes. However, few studies have evaluated the impact of advance directives (i.e., formal ACP) or goals-of-care conversations (i.e., informal ACP) on such care. This study aimed to examine the relationship between each of formal and informal ACP and goal-concordant end-of-life care among older Americans and to determine whether their impact differed between individuals identified as White, Black, or Hispanic. METHODS We conducted a retrospective cohort study using 2012-2018 data from the biennial Health and Retirement Study. We examined the relationships of interest using two, separate multivariable logistic regression models. Model 1 regressed a proxy report of GCC on formal and informal ACP and sociodemographic and health-related covariates. Model 2 added interaction terms between race/ethnicity and the two types of ACP. RESULTS Our sample included 2048 older adults. There were differences in the proportions of White, Black, and Hispanic decedents who received GCC (83.1%, 75.3%, and 71.3%, respectively, p < 0.001) and in the use of each type of ACP by racial/ethnic group. In model 1, informal compared with no informal ACP was associated with higher odds of GCC (adjusted odds ratio = 1.38 [95% confidence interval, 1.05-1.82]). In model 2, Black decedents who had formal ACP were more likely to receive GCC than those who did not, but there were no statistically significant differences between decedents of different racial/ethnic groups who had no ACP, informal ACP only, or both types of ACP. CONCLUSIONS Our results build on previous work by indicating the importance of incorporating goals-of-care conversations into routine healthcare for older adults and encouraging ACP usage among racially and ethnically minoritized populations who use ACP tools at lower rates.
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Affiliation(s)
- Rachel A Lenko
- Department of Nursing, Calvin University School of Health, Grand Rapids, Michigan, USA
| | - Geoffrey J Hoffman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Sheria G Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Maria J Silveira
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Terri Voepel-Lewis
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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2
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Ward C, Montgomery K. End-of-Life Planning and the Influence of Socioeconomic Status among Black Americans: A Systematic Review. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2024; 27:21-30. [PMID: 38449829 PMCID: PMC10911982 DOI: 10.14475/jhpc.2024.27.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
Purpose The purpose of this systematic review is to explore end-of-life (EOL) care planning and the impact of socioeconomic status (SES) among people who identify as Black or African American. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were used to guide and inform this systematic review process. The following academic electronic databases with publications that reflected the interdisciplinary fields related to the research objective were searched APA PsycINFO, CINHAL, PubMed, Scopus, and Social Work Abstracts. Results After the authors conducted the search, 14 articles (from 13 studies) ultimately met the criteria for inclusion. The results substantiated significant concerns highlighted in previous literature regarding SES and its relation to EOL planning, but also revealed an absence of original work and interventions to increase engagement in EOL planning among Black and African American populations. Conclusion Black individuals deserve an equitable EOL experience. Researchers, practitioners, and policymakers need to move towards advocacy and action to meet this important need.
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Affiliation(s)
- Chesney Ward
- College of Social Work, University of Tennessee, Knoxville TN, USA
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3
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Walter JK, Feudtner C, Cetin A, DeWitt AG, Zhou M, Montoya-Williams D, Olsen R, Griffis H, Williams C, Costarino A. Parental communication satisfaction with the clinical team in the paediatric cardiac ICU. Cardiol Young 2024; 34:282-290. [PMID: 37357911 PMCID: PMC10749983 DOI: 10.1017/s1047951123001555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Understanding parents' communication preferences and how parental and child characteristics impact satisfaction with communication is vital to mitigate communication challenges in the cardiac ICU. METHODS This cross-sectional survey was conducted from January 2019 to March 2020 in a paediatric cardiac ICU with parents of patients admitted for at least two weeks. Family satisfaction with communication with the medical team was measured using the Communication Assessment Tool for Team settings. Clinical characteristics were collected via Epic, Pediatric Cardiac Critical Care Consortium local entry and Society for Thoracic Surgeons Congenital Heart Surgery Databases. Associations between communication score and parental mood, stress, perceptions of clinical care, and demographic characteristics along with patient demographic and clinical characteristics were examined. Multivariable ordinal models were conducted with characteristics significant in bivariate analysis. RESULTS In total, 93 parents of 84 patients (86% of approached) completed surveys. Parents were 63% female and 70% White. Seventy per cent of patients were <6 months old at admission, 25% had an extracardiac abnormality, and 80% had a cardiac surgery this admission. Parents of children with higher pre-surgical risk of mortality scores (OR 2.875; 95%CI 1.076-7.678), presence of surgical complications (72 [63.0, 75.0] vs. 64 [95%CI 54.6, 73] (p = 0.0247)), and greater satisfaction with care in the ICU (r = 0.93922; p < 0.0001) had significantly higher communication scores. CONCLUSION These findings can prepare providers for scenarios with higher risk for communication challenges and demonstrate the need for further investigation into interventions that reduce parental anxiety and improve communication for patients with unexpected clinical trajectories.
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Affiliation(s)
- Jennifer K Walter
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arzu Cetin
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron G DeWitt
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Zhou
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rob Olsen
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine Williams
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew Costarino
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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4
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McCarthy EP, Lopez RP, Hendricksen M, Mazor KM, Roach A, Rogers AH, Epps F, Johnson KS, Akunor H, Mitchell SL. Black and white proxy experiences and perceptions that influence advanced dementia care in nursing homes: The ADVANCE study. J Am Geriatr Soc 2023; 71:1759-1772. [PMID: 36856071 PMCID: PMC10258152 DOI: 10.1111/jgs.18303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/08/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Regional, facility, and racial variability in intensity of care provided to nursing home (NH) residents with advanced dementia is poorly understood. MATERIALS AND METHODS Assessment of Disparities and Variation for Alzheimer's disease NH Care at End of life (ADVANCE) is a multisite qualitative study of 14 NHs from four hospital referral regions providing varied intensity of advanced dementia care based on tube-feeding and hospital transfer rates. This report explored the perceptions and experiences of Black and White proxies (N = 44) of residents with advanced dementia to elucidate factors driving these variations. Framework analyses revealed themes and subthemes within the following a priori domains: understanding of advanced dementia and care decisions, preferences related to end-of-life care, advance care planning, decision-making about managing feeding problems and acute illness, communication and trust in NH providers, support, and spirituality in decision-making. Matrix analyses explored similarities/differences by proxy race. Data were collected from June 1, 2018 to July 31, 2021. RESULTS Among 44 proxies interviewed, 19 (43.1%) were Black, 36 (81.8%) were female, and 26 (59.0%) were adult children of residents. In facilities with the lowest intensity of care, Black and White proxies consistently reported having had previous conversations with residents about wishes for end-of-life care and generally better communication with providers. Black proxies held numerous misconceptions about the clinical course of advanced dementia and effectiveness of treatment options, notably tube-feeding and cardiopulmonary resuscitation. Black and White proxies described mistrust of NH staff but did so towards different staffing roles. Religious and spiritual beliefs commonly thought to underlie preferences for more intense care among Black residents, were rarely, but equally mentioned by race. CONCLUSIONS This report refuted commonly held assumptions about religiosity and spirituality as drivers of racial variations in advanced dementia care and revealed several actionable facility-level factors, which may help reduce these variations.
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Affiliation(s)
- Ellen P McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruth Palan Lopez
- School of Nursing, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Meghan Hendricksen
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ashley Roach
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Anita Hendrix Rogers
- Department of Nursing, The University of Tennessee at Martin, Martin, Tennessee, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kimberly S Johnson
- Division of Geriatrics, Department of Medicine, Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Veteran Affairs Medicine Center, Durham, North Carolina, USA
| | - Harriet Akunor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Racism as the fundamental cause of ethnic inequities in COVID-19 vaccine hesitancy: A theoretical framework and empirical exploration using the UK Household Longitudinal Study. SSM Popul Health 2022; 19:101150. [PMID: 35765366 PMCID: PMC9225926 DOI: 10.1016/j.ssmph.2022.101150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/12/2022] [Accepted: 06/16/2022] [Indexed: 11/01/2022] Open
Abstract
Ethnic inequities in COVID-19 vaccine hesitancy have been reported in the United Kingdom (UK), and elsewhere. Explanations have mainly focused on differences in the level of concern about side effects, and in lack of trust in the development and efficacy of vaccines. Here we propose that racism is the fundamental cause of ethnic inequities in vaccine hesitancy. We introduce a theoretical framework detailing the mechanisms by which racism at the structural, institutional, and interpersonal level leads to higher vaccine hesitancy among minoritised ethnic groups. We then use data from Wave 6 of the UK Household Longitudinal Study COVID-19 Survey (November to December 2020) to empirically examine these pathways, operationalised into institutional, community, and individual-level factors. We use the Karlson-Holm-Breen method to formally compare the relationship between ethnicity and vaccine hesitancy once age and gender, sociodemographic variables, and institutional, community, and individual-level factors are accounted for. Based on the Average Partial Effects we calculate the percentage of ethnic inequities explained by each set of factors. Findings show that institutional-level factors (socioeconomic position, area-level deprivation, overcrowding) explained the largest part (42%) of the inequity in vaccine hesistancy for Pakistani or Bangladeshi people, and community-level factors (ethnic density, community cohesion, political efficacy, racism in the area) were the most important factors for Indian and Black groups, explaining 35% and 15% of the inequity, respectively. Our findings suggest that if policy intervened on institutional and community-level factors - shaped by structural and institutional racism - considerable success in reducing ethnic inequities might be achieved.
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Golla V, Allen Lapointe NM, Silberberg M, Wang V, Lentz TA, Kaye DR, Sorenson C, Saunders R, Kaufman BG. Improving health equity for older people with serious illness through value based payment reform. J Am Geriatr Soc 2022; 70:2180-2185. [PMID: 35474173 DOI: 10.1111/jgs.17815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Vishnukamal Golla
- National Clinician Scholars Program, Duke University, Durham, North Carolina, USA.,Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, North Carolina, USA.,Health Services Research and Development, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Nancy M Allen Lapointe
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mina Silberberg
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Virginia Wang
- Health Services Research and Development, Durham VA Healthcare System, Durham, North Carolina, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Trevor A Lentz
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Deborah R Kaye
- Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, North Carolina, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| | - Corinna Sorenson
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA.,Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Robert Saunders
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Brystana G Kaufman
- Health Services Research and Development, Durham VA Healthcare System, Durham, North Carolina, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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7
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Assari S, Zare H. Beyond access, proximity to care, and healthcare use: sustained racial disparities in perinatal outcomes due to marginalization-related diminished returns and racism. J Pediatr Nurs 2022; 63:e161-e163. [PMID: 34629226 DOI: 10.1016/j.pedn.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Shervin Assari
- Marginalization-Related Diminished Returns (MDRs) Research Center, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA; Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA; Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; University of Maryland Global Campus, Health Services Management, Adelphi, MD, USA.
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