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From Barriers to Assets: Rethinking factors impacting advance care planning for African Americans

Published online by Cambridge University Press:  05 June 2018

Justin J. Sanders Open the ORCID record for Justin J. Sanders [Opens in a new window] ,
Kimberly S. Johnson ,
Kimberly Cannady ,
Joanna Paladino ,
Dee W. Ford ,
Susan D. Block  and
Katherine R. Sterba
Justin J. Sanders*
Affiliation:
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
Kimberly S. Johnson
Affiliation:
Department of Medicine, Duke University School of Medicine, Durham, NC
Kimberly Cannady
Affiliation:
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
Joanna Paladino
Affiliation:
Department of Medicine, Brigham and Women's Hospital, Boston, MA
Dee W. Ford
Affiliation:
Department of Medicine, Medical University of South Carolina, Charleston, SC
Susan D. Block
Affiliation:
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
Katherine R. Sterba
Affiliation:
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
*
Author for correspondence: Justin J. Sanders, M.D., M.Sc., Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, LW670, Boston, MA 02215. E-mail: [email protected]
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Abstract

Objective

We aimed to explore multiple perspectives regarding barriers to and facilitators of advance care planning (ACP) among African Americans to identify similarities or differences that might have clinical implications.

Method

Qualitative study with health disparities experts (n = 5), community members (n = 9), and seriously ill African American patients and caregivers (n = 11). Using template analysis, interviews were coded to identify intrapersonal, interpersonal, and systems-level themes in accordance with a social ecological framework.

Result

Participants identified seven primary factors that influence ACP for African Americans: religion and spirituality; trust and mistrust; family relationships and experiences; patient-clinician relationships; prognostic communication, care preferences, and preparation and control. These influences echo those described in the existing literature; however, our data highlight consistent differences by group in the degree to which these factors positively or negatively affect ACP. Expert participants reinforced common themes from the literature, for example, that African Americans were not interested in prognostic information because of mistrust and religion. Seriously ill patients were more likely to express trust in their clinicians and to desire prognostic communication; they and community members expressed a desire to prepare for and control the end of life. Religious belief did not appear to negate these desires.

Significance of results

The literature on ACP in African Americans may not accurately reflect the experience of seriously ill African Americans. What are commonly understood as barriers to ACP may in fact not be. We propose reframing stereotypical barriers to ACP, such as religion and spirituality, or family, as cultural assets that should be engaged to enhance ACP. Although further research can inform best practices for engaging African American patients in ACP, findings suggest that respectful, rapport-building communication may facilitate ACP. Clinicians are encouraged to engage in early ACP using respectful and rapport building communication practices, including open-ended questions.

Keywords

Advance care planningAfrican Americanscommunicationserious illnessqualitative
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 3 , June 2019 , pp. 306 - 313
Copyright
Copyright © Cambridge University Press 2018 

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