Empowering the People: Introducing an Advance Care Planning Conversation to Improve Cultural Sensitivity Among African American Heart Failure Patients (W215C)

Abstract

1.Describe health disparities in advance care planning (ACP) engagement among African American patients with heart failure.2.Evaluate the effect of Respecting Choices, an evidence-based ACP facilitation program on ACP knowledge, contemplation, and self-efficacy.3.Identify culturally sensitive strategies to enhance ACP engagement to decrease health disparities in African American heart failure patients. Advance care planning (ACP) improves goal-concordant care and communication. African Americans (AA) are disproportionately affected by heart failure (HF) with higher morbidity and mortality supporting the need for ACP engagement in this clinical population. Yet, few AAs engage in ACP due to a lack of knowledge and culturally sensitive interventions. Assess the effect of a culturally sensitive delivery of Respecting Choices®, an evidence-based ACP facilitation program on ACP knowledge, contemplation, and self-efficacy. African American heart failure patients ≥ age 45 were recruited from the UAB Hospital Heart Failure Transitional Care Services for Adults (HRTSA) Clinic to participate in a quality improvement project aiming to improve ACP engagement. Participants received the one-on-one culturally sensitive 90-minute Respecting Choices® intervention delivered by an AA nurse clinician in local communities. ACP engagement was assessed in three domains including knowledge, contemplation, and self-efficacy using the validated ACP engagement survey by Sudore et al. at pre- and post-intervention. Thirty-three HF patients from the HRTSA clinic were approached; 28 were eligible; and 15 were enrolled from January to March 2019. Average age was 56.6 years (SD 6.7), all (n=15, 100%) were uninsured/underinsured; 80% (n=12) were male; 80% (n=12) had a high school or higher education; and 87% (n=13) identified as Christians. Participants reported improvement in knowledge (pre=3.8 vs. post=4.6), contemplation (pre=3.2 vs. post=4.4), and self-efficacy (pre=3.6 vs. post=4.4) with higher scores indicating higher engagement (range 1-5). A culturally sensitive ACP Respecting Choices® session designed for AA HF patients has shown preliminary evidence to improve ACP engagement. There is an urgent need to expand and integrate culturally sensitive ACP interventions into routine clinical care to improve health equity in the AA HF population.