Uncertainty of Advance Care Planning Treatment Preferences among Diverse Older Adults

Abstract

1.Recognize that many patients may not be able to make definitive treatment decisions in advance.2.Identify the level of uncertainty patients experience during advance care planning when making treatment decisions based on hypothetical scenarios.3.Discuss the patient characteristics associated with uncertainty when making treatment decisions based on hypothetical scenarios. I. Background. Older persons may be unprepared to make advance treatment decisions and uncertain about their preferences. II. Research Objectives. Using a hypothetical scenario, we assessed certainty about treatment preferences among older adults. III. Methods. Two hundred five English- and Spanish-speakers aged 50 years were recruited from a county hospital in San Francisco. The scenario: Imagine your doctor said that you have a serious disease and may die within 6 months. You then get very sick. Your doctor thinks that life-support treatments will NOT help you live longer and will NOT cure your disease. Participants were asked to choose: all life support (LS); try LS with an option of stopping; or no LS, and to rate their decisional certainty (very sure, sure, not so sure, not sure at all). Participants were considered completely certain if they reported very sure. IV. Results. Mean age of participants was 61 years and 31% were Latino, 25% white, 24% African American, 9% Asian/Pacific Islander, 10% multi-ethnic, 52% female, 40% had limited literacy, 29% were Spanish-speaking, and 69% had fair-to-poor health status. Ninety-two participants (45%) reported not being entirely certain of their preferences: 21% wanted all LS, 30% to try LS, and 49% no LS. Uncertainty did not vary by treatment preference (P=.35). In adjusted multivariable analyses, uncertainty was associated with being Asian/Pacific Islander (OR 4.9; 95% CI, 1.4–16.9) and Latino vs. White (OR 2.5; 95% CI 1.0–5.8); having limited vs. adequate literacy (OR 1.9; 95% CI 1.0–3.7), and fair-to-poor vs. good-to-excellent health (OR 2.0; 95% CI 1.0–4.2). V. Conclusion. Approximately half of diverse older adults were uncertain about a scenario-based advance treatment decision. Uncertainty was more common among minorities and participants with limited literacy and poor health. VI. Implications for Research, Policy, and Practice. Many patients may be unable to make definitive advance treatment decisions. Culturally sensitive, literacy-appropriate tools are needed to help patients prepare for decision-making about their medical care. Structure and Processes of Care; Cultural Aspects of Care