Community-Based Interventions to Increase Use of Advance Care Planning in Racial/Ethnic Minority Older Adults: A Systematic Review (SCI957)

Abstract

1.Compare the community-based advance care planning interventions for racial/ethnic minority older adults.2.Appraise the community-based advance care planning interventions aimed at increasing engagement in racial/ethnic minorities. Racial/ethnic minority older adults in the United States (US) often experience access, language, and cultural barriers to advance care planning. Our aim was to summarize and appraise the current science on interventions aimed at increasing advance care planning in racial/ethnic minority, community-dwelling older adults. We systematically searched PubMed, CINAHL, and Embase databases until April 2020. We included articles representing interventional, community-based, primary research in the US for racial/ethnic minority older adults in the US. We excluded studies that targeted caregiver, family, or surrogates due to wide variation in demographics. Following PRISMA guidelines, two researchers independently screened articles identified in the systematic search, reviewed eligible articles, and abstracted data using a standardized data extraction form. Two reviewers appraised the quality of the included articles using the Downs and Black checklist and a third reviewer settled discrepancies. 1823 abstracts and titles were reviewed, five met the inclusion criteria, which represented four unique interventions. Interventions were conducted in Asian American (n=2) and Hispanic (n=2) communities. Interventions included educational nurse-led workshops (n=2) and one-on-one social worker-led sessions (n=2). Quality appraisal identified methodological weaknesses including convenience samples and self-reported outcomes. Outcomes measured were intention to complete or completion of advance directive or advance care planning discussion, an improvement in advance directive knowledge, beliefs, and attitudes toward and comfort with end-of-life care planning. The interventions increased intention to or completion of an advance directive and improved advance care planning knowledge, beliefs, and attitudes. However, Results were inconclusive regarding promoting advance care planning discussions with family and health care providers. Existing literature on interventions to increase advance care planning in US racial/ethnic minority older adults is limited and specific to certain populations. Although the Results from these studies were promising, high-quality interventions that reflect the diverse needs and barriers to advance care planning are needed.