Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries

Abstract

Letters Chicago; Ann Thomas, MD, MPH, Oregon Public Health Division, Portland; Teri Moser Woo, PhD, Pacific Lutheran University, Tacoma, Washington; Rachel M. Zetts, The Pew Charitable Trusts, Washington, DC. Conflict of Interest Disclosures: Dr Hersh has received funding from the CDC, the Agency for Healthcare Research and Quality, Pfizer/Joint Commission, and Merck. No other conflicts are reported. Funding/Support: This project was made possible through a partnership with the CDC Foundation. Support for this project was provided by Pew Charitable Trusts. Role of the Funder/Sponsor: The CDC participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The Pew Charitable Trusts participated in the interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The Pew Charitable Trusts sponsored in-person and telephone author meetings and supported some author travel to in-person meetings. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. Additional Contributions: Tia Carter, MS, Allan Coukell, BSc Pharm, and Elizabeth Jungman, JD, MPH, of The Pew Charitable Trusts assisted in convening author meetings. They did not receive any compensation for their role in the study. 1. The White House. National action plan for combating antibiotic resistant bacteria. https://www.whitehouse.gov/sites/default/files/docs/national_action _plan_for_combating_antibotic-resistant_bacteria.pdf. Accessed August 3, 2015. 2. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 3. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259-273. 4. Piccirillo JF, Mager DE, Frisse ME, Brophy RH, Goggin A. Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis. JAMA. 5. Capra AM, Lieu TA, Black SB, Shinefield HR, Martin KE, Klein JO. Costs of otitis media in a managed care population. Pediatr Infect Dis J. 2000;19(4): Table 1. Characteristics of Participants Participants, No. (%) a Variable Sociodemographic characteristics Age, y Sex Female Male Race/ethnicity White Black/African American Hispanic/Latino English-speaking Spanish-speaking Other Education High school diploma or less Greater than high school Annual income, b $ Health-related characteristics Self-rated health Excellent or very good Good Fair or poor Dementia c None Possible or probable dementia Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries Advance care planning (ACP) is an iterative process that in- cludes discussions about preferences for end-of-life (EOL) care, completion of advance directives (AD), and designation of a surrogate decision maker in a durable power of attorney for health care (DPOA). 1,2 Engagement in ACP has increased over time. 3 However, the rising tide of ACP may not have lifted all boats equally. Minorities, those with lower levels of educa- tional attainment, and the poor may not have benefited from rising rates of ACP to the same extent that white, highly edu- cated, affluent individuals have. Rates of ACP by older Lati- nos in particular are unknown. Further, we do not know if ACP uptake is greater among those in worse health and with poorer prognoses. Methods | We used data from the National Health and Aging Trends Study (NHATS), a longitudinal cohort study using a nationally representative sample of community-dwelling Medi- care beneficiaries ages 65 years and older (2011 round 1 re- sponse rate, 71%; 2012 round 2 response rate, 86%). 4 This cross- sectional analysis used a random one-third sample of 2015 d Number of chronic medical conditions None Number of ADLs requiring help e 1 or 2 (continued) participants who responded to a supplemental module on ACP fielded in 2012. This study was considered exempt by the institutional review board of the University of California, San Francisco. Outcome variables included 3 self-reported elements of ACP: (1) discussing with any individual the medical treat- ment desired if seriously ill in the future (EOL discussion), (2) having legal arrangements for a proxy to make decisions about medical care (DPOA), or (3) having written instructions about JAMA Internal Medicine December 2016 Volume 176, Number 12 (Reprinted) jamainternalmedicine.com Copyright 2016 American Medical Association. All rights reserved. Downloaded From: http://jamanetwork.com/pdfaccess.ashx?url=/data/journals/intemed/935892/ by a UCSF LIBRARY User on 06/15/2017