Attitudes Toward Advance Care Planning: Pilot Testing a Randomized Controlled Trial (RCT) for Older Latinos with Chronic Illnesses

Background:  This study examines older Latinos’ attitudes toward advance care planning (ACP) in a randomized controlled pilot trial.  Informed decision-making is essential to ACP.  ACP education and advance directive (AD) documentation for end of life (EOL) care is standard practice for seriously ill, older adults; however, minority individuals are less likely to receive personalized information that adequately guides them towards medical decision-making and are less likely to communicate their wishes to their healthcare providers.  Historically, vulnerable, minority patients lack information and experience significant health disparities (e.g., economic, social, linguistic, cultural) that limit optimal decision-making and EOL communication.^6-8

Methods: .  We conducted a prospective, pretest/posttest, two-group, randomized, community-based pilot trial using mixed data collection methods. This study uses community-engaged research (CEnR) to assist with reaching and recruiting hard-to-reach populations of older Latinos with advance chronic conditions in Southern New Mexico to pilot test AD education only versus AD education plus counseling called ACP – I Plan.  Masters level trained social workers provide motivation interviewing to reduce resistance for ACP.³

Results:  Older Latinos ≥50 years were contacted (N=104). At baseline, 74 completed a pretest survey focused on attitudes and knowledge about ACP, number of chronic medical conditions, and emotional distress of anxiety and/or depression. Participants were randomized to usual care 39 (UC) and treatment 35 (TX) groups.  Six dropped out prior to posttest, 3 from TX due to sickness (n=1) or could not be located (n=2), and the same for UC.  Completion rates were 91.4% UC and 92.3% TX groups.  All participants were Latino/Hispanic, born in the US (48%) or Mexico (51.4%) on average in the US for 25 years, majority were female 76.5%, 48.6% preferred Spanish, 31.4% had less than 6^th grade education.  For education or use of preferred language (Spanish or English), no differences were found between groups.  Post-intervention data indicate that participants in the TX group were more likely to complete an advance directive related to UC.

Implications:

This study highlights findings of a community-based RCT pilot trial ACP – I Plan. While previous research finds low participation rates among Hispanics/Latinos in research, this study successfully enrolled and completed the trial with 68 participants enrolled from southern New Mexico. Development of the ACP – I Plan intervention was guided by a conceptual model of motivational interviewing and readiness-to-change intended to improve ACP communication and AD documentation for Latinos with chronic medical conditions.

When older Latinos experience chronic illnesses, they may become more vulnerable when entering the medical system.  Without previous decision-making discussions and lack of AD documentation, they can rely on family members for medical decision-making. However, surrogate preferences can differ from patients’ goals, leading to family conflict regarding treatment options.  This study indicates that older Latinos are receptive to ACP communication and appreciate an opportunity to begin early discussions to prevent family conflict and confusion for everyone.