A Systematic Review of Advance Care Planning and Palliative Care Interventions for Racial and Ethnic Minority Populations

Background: Despite a long history of substantiated recognition of the need to reduce disparities in health and health care in the United States, racial and ethnic minorities continue to experience substandard access to quality health care throughout the life course. Providing high-quality advance care planning and palliative care for racial and ethnic minority populations is an important health issue. This systematic review examines existing palliative care and advance care planning interventions that aim to improve health and quality of life outcomes for racial and ethnic minority populations in the United States.

Methods: A systematic review was conducted based on PRISMA guidelines. Articles from MEDLINE, PsychINFO, CINAHL, and EMBASE were searched through November 1^st 2018. Peer-reviewed studies that implemented interventions on palliative care or advance care planning were considered eligible for review. Data from studies were extracted using pre-specified inclusion and exclusion criteria. Quality was appraised using the Cochrane Collaboration’s tool for assessing risk of bias in quantitative studies. 

Results: Thirteen articles met inclusion criteria. Four studies were randomized controlled trials, four used a pre/post-test two-group design, one study utilized posttest only two-group design, and four studies employed a pre/posttest single group design. Only three studies were evaluated as high quality or of being at low risk for bias. Eleven of the thirteen studies utilized individual-level intervention strategies to reduce health disparities focusing primarily on outcomes related to advanced directives and advanced care planning. Four studies targeted African Americans, seven Latinos, and two studies focused on Asian Americans.

Implications: The effectiveness of advance care planning and palliative care interventions in improving health and quality of life outcomes for racial and ethnic minority populations is uncertain. High-quality intervention studies that address the complex multi-level factors of health disparities, are needed. This review has particular relevance to the social work profession, as research to improve health disparities is rooted in a commitment to health equity, service, and social justice.