Durable Power Of Attorney Research Articles

Palliative Care For Patients With Hematologic Malignancies: A Profile Of Patients With Blood Cancers Referred To The Choice Hospice Network

BackgroundPublished literature provides an incomplete description of the palliative care needs of the hematologic malignancies (HM) population. We sought to compare characteristics of hospice patients with HM vs. those with solid tumors. MethodsPatient data (2008-2012) were extracted from the electronic records of 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness). We identified the subset with HM using ICD-9 codes, comparing them to the subset with all other neoplasias using bivariate analyses. ResultsOf the 48,147 cancer patients, 3,518 (7.3%) had a hematologic malignancy, with rates not changing substantially over the 5-year study period (Table 1). HM patients were somewhat older and more often male, with a slight, but significant tendency to be more often Caucasian (see Table 1). At time of admission, HM patients had worse physical functioning by Palliative Performance Scale (PPS) scores (32% vs. 24% were below 40; p<0.001) and were more likely to be admitted to an inpatient hospice or nursing home setting vs. home (OR 1.34, CI 1.16-1.56, and OR 1.54, CI 1.39-1.72; p<0.001). HM patients were more likely to have a hospice length of stay (LOS) of 1 day (OR 1.66, CI 1.49-1.86; p<0.001), or of less than 7 days (OR 1.68, CI 1.56-1.81; p<0.001). Patients with leukemia were more likely to have a LOS of 1 day compared to those with lymphoma (OR 1.31, CI 1.1-1.56; p=0.002), and were more likely to die during the study period (HR 1.23, CI 1.13-1.34; p<0.001). Patients with multiple myeloma or myelodysplastic syndrome were more likely than other HM patients to be taking an opioid at admission (OR 1.37, CI 1.12-1.67; p=0.002, and OR 1.29, CI 1.01-1.64; p =0.042). Patients with myelodysplasia were also more likely to have an advance directive or durable power of attorney in place at admission compared to other HM patients (OR 1.36, CI 1.07-1.72; p=0.012). ConclusionsPatients with hematologic malignancies who are referred to hospice appear to be more seriously ill at time of admission, with worse physical functioning scores by PPS and shorter length of stay compared to other cancer patients. Targeted efforts to better understand the palliative care needs of the hematologic malignancies population are warranted. Disclosures:Abernethy:American Academy of Hospice and Palliative Medicine: Membership on an entity's Board of Directors or advisory committees; Biovex: Research Funding; DARA: Research Funding; Helsinn: Consultancy, Research Funding; MiCo: Research Funding; Dendreon: Research Funding; Pfizer: Consultancy, Research Funding; Alexion: Research Funding; Amgen: Research Funding; Genentech: Research Funding; Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy; Advoset: Membership on an entity's Board of Directors or advisory committees; Orange Leaf Associates, LLC: Membership on an entity's Board of Directors or advisory committees.

ADVANCE CARE DIRECTIVES FOR PERSONS WITH MENTAL ILLNESS

The movement toward patient-centred care has fueled considerable interest in Psychiatric Advance Directives (PADs), analogous to medical advance directives and health care proxies, as a possible remedy for loss of...

Advance Care Planning and the Quality of End‐of‐Life Care in Older Adults

To determine whether advance care planning influences quality of end-of-life care. In this observational cohort study, Medicare data and survey data from the Health and Retirement Study (HRS) were combined to determine whether advance care planning was associated with quality metrics. The nationally representative HRS. Four thousand three hundred ninety-nine decedent subjects (mean age 82.6 at death, 55% women). Advance care planning (ACP) was defined as having an advance directive (AD), durable power of attorney (DPOA) or having discussed preferences for end-of-life care with a next of kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤ 3 days). Seventy-six percent of subjects engaged in ACP. Ninety-two percent of ADs stated a preference to prioritize comfort. After adjustment, subjects who engaged in ACP were less likely to die in a hospital (adjusted relative risk (aRR) = 0.87, 95% confidence interval (CI) = 0.80-0.94), more likely to be enrolled in hospice (aRR = 1.68, 95% CI = 1.43-1.97), and less likely to receive hospice for 3 days or less before death (aRR = 0.88, 95% CI = 0.85-0.91). Having an AD, a DPOA or an ACP discussion were each independently associated with a significant increase in hospice use (P < .01 for all). ACP was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an AD, assigning a DPOA and conducting ACP discussions are all important elements of ACP.

A Geriatrician's Gifts

A Geriatrician's Gifts

Exploring the Limits of Autonomy

AbstractMr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery.His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment?

Proactive Dementia Care: A Five-Year Experience in Dementia Caregiver Counseling (P07.156)

Objective: To determine whether health educator (HE) and social worker (SW) counseling at time of diagnosis improves compliance with doctor advice related to dementia care. Background The contributions of HE and SW counseling to dementia care are underrecognized. Design/Methods: 1577 patients with a cognitive disorder were seen in a dementia clinic between January 2006 and December, 2010. All patients were referred to a HE and to a SW. We retrospectively determined how often a durable power of attorney for health care (DPOA) was present in the medical record and the enrollment level in our Gift to Life autopsy program (GTL). Results: Patients reflected the typical demographics of a dementia specialty clinic - 682 were men (43.24%), mean age 72.8 (SD 11.04), range 29 – 98 years, education 0 – 20 years, mean 14.25 (SD 2.9), Mini-Mental Status Exam (MMSE) or equivalent 0 – 30, mean 22.08 (SD 6.85). 1167 (74%) met with the health educator at least once, and 353 (22%) met with the social worker. We performed 4 separate logistic regression models with DPOA or GTL enrolment as outcomes, and SW visit (yes/no), or HE visit (yes/no) as predictor and controlled for gender and dichotomized for age, years of education, symptom years, and MMSE using cut off point 70, 12, 2, and 24 respectively. Exposure to either SW or HE was associated with DPOA documentation and enrollment in GTL.outcome Predictor Used observations OR (95% CI) pDPOA HE 1247 1.68 (1.29, 2.19) Conclusions: HE and/or SW counseling increases compliance with physician advice to complete a DPOA and to enroll in GTL. Prospective studies are needed to demonstrate that HE and SW improve quality of life and reduce costs. Supported by: Anonymous donor. A grant from The Center for Health Improvement. The Center for Alzheimer9s Care, Imaging, and Research at the University of Utah. Disclosure: Dr. Zamrini has nothing to disclose. Dr. Mandal has nothing to disclose. Dr. Andersen has nothing to disclose. Dr. Simpson has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Greene has nothing to disclose. Dr. Ying has nothing to disclose. Dr. King has received research support from Alzheimer9s Association and the National Institute on Aging. Dr. Foster has received personal compensation for activities with GE Healthcare and Bristol-Myers Squibb Company. Dr. Foster received research support from Eli Lilly & Company, Janssen Alzheimer Immunotherapy, and Pfizer Inc.

Incidence and Predictors of Advance Care Planning Among Persons With Cognitive Impairment

Persons with mild cognitive impairment (MCI) and Alzheimer disease (AD) are at heightened risk for future decisional incapacity. We sought to characterize advance care planning (ACP) rates over time in individuals who had no advance directives (living will or durable power of attorney) in place when they initially presented for a cognitive evaluation. Retrospective analysis of data that had been prospectively collected. Alzheimer's Disease Research Center memory disorders clinic. Persons (N = 127) with a diagnosis of MCI or early AD (n = 72) or moderate to severe AD (n = 55) and no advance directives upon initial presentation for a cognitive evaluation. Extraction of responses to items pertaining to ACP assessed during annual semistructured interviews. By 5 years of follow-up, 39% of the sample had initiated ACP, with little difference by baseline diagnosis. Younger subjects (younger than 65 years) were significantly more likely to initiate advance directives (43%) than older subjects (37%). This age effect was more pronounced in men than in women as well as in married subjects, those with a family history of dementia, those with no depressive disorder, and subjects with moderate to severe AD (versus those with MCI or early AD) at baseline. Only a minority of subjects initiated ACP. The findings suggest the need for interventions aimed at enhancing ACP completion rates, particularly among older adults with cognitive impairment, since these individuals may have a time-limited opportunity to plan for future medical, financial, and other major life decisions.

The Paradox in Madness: Vunerability Confronts the Law

This article argues that the durable power of attorney (DPA) is being used to take advantage of many individuals who are on the edge of incompetence, exposing the law’s own vulnerability in protecting these persons. It suggests that additional oversight of DPAs through holistic evaluations of DPA principals, better transfer rituals, greater community involvement, and mandatory alternative dispute resolution for contested cases can create a more balanced approach that permits both autonomy and protection of the mentally ill against their agents.

Hoping for the best and preparing for the worst: end-of-life attitudes of the elderly

This paper describes findings from research based on 514 elderly persons (mean age=76.7, SD 8.0) living in a US metropolitan community about their attitudes toward and plans for end of...

Acceptors and Rejecters of Life-Sustaining Treatment

Because most patients are decisionally incapacitated at the end of life, health care providers often rely on advance directives or proxies’ substituted judgment for guidance in treatment decisions. In a survey of 202 older adults and their respective proxies, we compared older adults who would reject life-sustaining care to those who would accept it in terms of the availability and accuracy of the information sources that providers would consult, viz., whether the patient had (a) completed a living will, (b) designated a durable power of attorney for health care (DPAHC), and (c) discussed wishes with a proxy; and (d) we calculated the accuracy of proxies’ substituted judgment. Older adults who would accept all treatments were significantly less likely to have completed a living will, assigned a DPAHC, or discussed their wishes with their proxies, and their proxies were much less accurate in understanding their wishes.

A Rapid Response Veteran Affairs Outpatient Palliative Care Consult Team (316-B)

age 51.7 years; 62.4% had < 12 years education; 74.6% foreign born; 10.2% reported any employment. Participants reported high levels of pain (75% rated average $ 5 on 10-point scale) and depression (53.8% scored 3+ on PHQ-2) and poor overall quality of life (71.9% rated ‘‘fair’’, ‘‘poor’’ or ‘‘very poor’’). Just 15 (7.6%) reported having a durable power of attorney or living will. Of n 1⁄4164 with known vital status, 54.3% died within one year. Based on intention-to-treat comparisons, there were no differences for survival or service use (adjusted for survival time) in the follow-up period. Aim. Understand the impact of palliative care consults in the ED on outcomes. Methods/session descriptions. Presentation of scientific study. Conclusion. Results suggest a need for PC consultation among vulnerable patients in ED. More complex analyses of health and social factors are needed to evaluate the effect of PC intervention on health system outcomes. Implications for research, policy, or practice. Little data exists on the integration of PC in the ED and how this impacts quality measures and outcomes.

ED HELP: Can Early ED Consultation Impact Care (316-A)

1.Identify the PC needs of low-income emergency department (ED) patients with end-stage chronic illness.2.Determine the impact of ED-based palliative care consultation on ED utilization and hospital length of stay. Background. Palliative care (PC) improves quality of life of seriously ill patients through the prevention and relief of suffering. Little data exist examining the role of early PC intervention in the emergency department (ED). Research objectives. (1) Identify the PC needs of low-income ED patients with end-stage chronic illness. (2) Determine the impact of ED-based PC consultation on ED utilization and hospital length of stay. Methods. Prospective, randomized controlled trial using time randomization in a large public hospital ED, comparing ED-based PC consultation versus usual care. Patients included adults able to participate in informed consent, not on psychiatric hold. Baseline PC needs were explored with a comprehensive enrollment interview. Outcome measures included use of hospital inpatient and emergency services during subsequent year. Descriptive statistics, bivariate comparisons, and general linear models univariate and repeated measures analyses were conducted using SPSS. Results. Of 393 patients approached, 198 consented and were assigned to intervention (88) and control (110) groups; 51% males; average age 51.7 years; 62.4% had < 12 years education; 74.6% foreign born; 10.2% reported any employment. Participants reported high levels of pain (75% rated average ≥ 5 on 10-point scale) and depression (53.8% scored 3+ on PHQ-2) and poor overall quality of life (71.9% rated “fair”, “poor” or “very poor”). Just 15 (7.6%) reported having a durable power of attorney or living will. Of n =164 with known vital status, 54.3% died within one year. Based on intention-to-treat comparisons, there were no differences for survival or service use (adjusted for survival time) in the follow-up period. Aim. Understand the impact of palliative care consults in the ED on outcomes. Methods/session descriptions. Presentation of scientific study. Conclusion. Results suggest a need for PC consultation among vulnerable patients in ED. More complex analyses of health and social factors are needed to evaluate the effect of PC intervention on health system outcomes. Implications for research, policy, or practice. Little data exists on the integration of PC in the ED and how this impacts quality measures and outcomes. Structure and Processes of Care

Miracles, Choices, and Justice

THE LANDMARK PATIENT PROTECTION AND AFFORDable Care Act of 2010 will soon extend insurance coverage to millions more individuals in the United States. Simultaneously, the first of the baby boom generation will reach age 65 years and enter the age group that has the highest rates of health care use. Meanwhile, technological advances in medicine continue to proliferate. As these trends intersect, difficult questions will arise about the who, what, and for how long of health care. The stories of 2 patients provide insights into the present and future states of health care in the United States. The first patient was an 89-year-old woman with atrial fibrillation and functional impairment requiring a caregiver 24 hours per day. She presented with acute rightsided hemiplegia and global aphasia. During the emergency department evaluation, she developed respiratory distress and was intubated. A middle cerebral artery clot was found on angiogram but a mechanical embolectomy to remove it was unsuccessful and the patient remained obtunded, unresponsive to verbal stimuli, with no spontaneous movement of the right upper and lower extremity. The patient’s son, who was her durable power of attorney for health care, remained hopeful for some recovery and wanted to proceed 10 days later with tracheostomy and gastrostomy tube placement. Two months after admission, her clinical status had not improved and she was transferred to a long-term care facility for ventilator-dependent patients. For this patient, it was the best and worst of times. She had access to a remarkable array of medical services that might have been helpful, but were not. For her, it was the age of hopelessness. Because of her son’s decisions, she was maintained in a state that most would not want. The second patient was an 81-year-old homeless woman with Parkinson disease who presented with a urinary tract infection. She had recently been discharged to a shelter after a prior urinary tract infection. On several previous occasions and now, her medical needs had met criteria for postacute rehabilitation but she had exhausted her 100 days of coverage under Medicare and would again need to be discharged to a shelter. In medicine there are 3 do’s: the can do, the actually do, and the should do. The can do reflects what is possible and is driven by science and technology. The can do has no bounds; more is always better. Innovations that treat disease are desirable and the government (eg, through the National Institutes of Health), foundations, and the private sector promote advancement of the can do. During the past 30 years, the can do has increased substantially and will continue to do so. Procedures and devices such as thrombectomies, intracardiac defibrillators, and stents for a variety of vessels were science fiction in the 1970s. Now they are commonplace and more are on the way. In contrast, what is actually done for patients is driven by clinicians and patients and is determined by availability of services, access to these services, insurance, practice patterns, and patient and clinician choices. Like the can do, the actually do has also increased over the last 3 decades. Discrepancies between what is possible and what is actually done result from underuse (failing to provide recommended care) or appropriate use (the should do). However, these discrepancies are not as large as they should be. The care that is actually provided also includes the provision of inappropriate health care that does not benefit patients (eg, unnecessary tests and procedures). Overuse is waste, which by some estimates is responsible for up to 30% of the health care spending. On the whole, the scorecard for the care actually provided is not impressive. Health care in the United States is characterized by high expenditures, poor performance on quality measures, and poor health status compared with other countries. The should do is determined by medical evidence with modification by personal, societal, and ethical values. For the first patient, the physicians believed that the should do was to provide comfort care during terminal illness and attempted to convey this to the patient’s son without success. Situations such as this are common in practice and often lead to countless hours of discussion and sometimes animosity between patients’ families and physicians. To date, there has been little investment in promoting the should do. At both individual patient care and

End-of-Life Terminology: The ED Patients’ Perspective

Accurate understanding of end-of-life terminology is essential to communications regarding end-of-life treatment preferences. This study was undertaken to assess the level of understanding of commonly used end-of-life medical terms among emergency department (ED) patients and visitors. In this prospective survey study, an oral structured interview was conducted in a university emergency department in 2008. Participants were asked to define 10 terms. Free text responses were scored by three investigators, using a health literacy 3-point scale (correct, partially correct, or incorrect). Among 303 participants (82% participation rate), 7.3% correctly defined 7 or more of 10 end-of-life terms. Terms most commonly understood included do not resuscitate (DNR) (56.3% correctly defined), ICU (51.8%), and durable power of attorney for health care (39.8%). Terms least correctly defined included resuscitation (15.3% correctly defined), physician-assisted suicide (9.4%), and euthanasia (7.4%). Factors associated with differences in accuracy in defining terms included age (age group 51–65 years had the highest accuracy), ethnicity (Caucasians had the highest accuracy), education (more education correlated with higher accuracy), and gender (females had higher accuracy). Income and personal advance directives were not associated with accuracy. A minority of participants (31%, n = 95) had previously completed an advance directive for themselves. In conclusion, ED patients and visitors demonstrated low levels of understanding of commonly used end-of-life medical terms. A minority of ED patients and visitors have completed advance directives. Completion of a personal advance directive does not correlate with an increase in knowledge of end-of-life terminology.

A literature review: Advance directives and patients with implantable cardioverter defibrillators

The purpose of this literature review is to describe the severity of and susceptibility for negative outcomes in patients with implantable cardioverter defibrillators (ICDs) who lack advanced directives. A comprehensive review of literature was conducted with articles selected from CINAHL, Pubmed, Ovid, Medline, evidence-based medicine, evidence-based nursing, and the Web of Science from 1990 to the present. Key words such as ICD, randomized controlled trials, case studies, advanced directives, end-of-life, living will, health care proxy, and durable power of attorney were used to identify specific studies. Advanced directives are becoming an essential part of care for the ICD population. The recommendations in the literature suggest that clinicians should initiate end-of-life discussions with their patients when they are healthy. The patients' preferences should be discussed often in patient care in case they would like changes made to their advance directive as their condition changes. Implementation of advanced directives in patients' medical care will need to be encouraged in the event of illness. Advanced practice nurses can provide clear explanations of patients' treatment choices in outpatient and inpatient settings.

Risk‐Reducing Legal Documents: Controlling Personal Health and Financial Resources

Every adult can eliminate the risk of losing control of personal health decisions and financial resources by having a last will and testament, health proxy, power of attorney, and living trust. Yet evidence suggests that less than a majority of adult Americans have these documents. We surveyed 900 adult Americans (25 plus years old) to determine what factors predict the possession of these risk-reducing documents. In total, 46% had a living will and testament, 32% a durable power of attorney, 30% a health proxy, and 18% a living trust. Events that prompt people with wealth to secure these documents, such as increasing age, getting married, having children, and experiencing a life-threatening event were the strongest predictors of having a will. These were also among the strongest predictors of having a health proxy, along with a personal history of being proactive, and a family history that fostered trust of attorneys. Affluence, age, and education were the strongest predictors of having a living trust, and the strongest correlate of having a durable power of attorney was having faced a life-threatening event, positive experiences with attorneys, and higher educational achievement.

Patient Perceptions on the Use of Advance Directives and Life Prolonging Technology

Use of advance directives is underutilized despite the Patient Self Determination Act of 1990. This study was undertaken to determine use and opinions of advance directives by patients at a multidisciplinary. Institutional Review Board-approved prospective survey of patients age 18 and over. Of 306 participants, 77 (25.2%) had a durable power of attorney and 45 (14.7%) had living wills. Of these, 226 (73.9%) responded that it was important to make health care wishes known to their doctor. Only 36 (15.9%) had done so. A total of 266 (86.9%) felt it was important to discuss health care wishes with their family and only 160 (60.1%) had done so. While adequately describing use and attitudes toward advance directives, it is significant to note that patients believe their wishes for end-of-life care will be honored; however, they fail to take the necessary steps to guarantee this.

Factors associated with discussion of care plans and code status at the time of hospital admission: Results from the Multicenter Hospitalist Study

Hospital admission is a time when patients are sickest and also often encountering an entirely new set of caregivers. As a result, understanding and documenting a patient's care preferences at hospital admission is critically important. To understand factors associated with documentation of care planning discussions in patients admitted to general medical services at 6 academic medical centers. Observational cohort study using data collected during the Multicenter Hospitalist Study, conducted between July 1, 2002 and June 30, 2004. Prospective trial enrolling patients admitted to general medicine services at 6 university-based teaching hospitals. Patients were eligible for this study if they were 18 years of age or older, admitted to a hospitalist or nonhospitalist physician, and able to give informed consent. Presence of chart documentation that the admitting team had discussed care plans with the patient within the first 24 hours of hospitalization. Notations such as "full code" were not counted as a discussion, whereas notations such as "discussed care wishes and plan with patient" were counted. A total of 17,097 patients over the age of 18 gave informed consent and completed an interview and chart abstraction; of these, 1776 (10.3%) had a code status discussion (CD) documented in the first 24 hours of their admission. Patients with a CD were older (69 years vs. 56 years, P < 0.0001), more often white (52.8% vs. 43.3%, P < 0.0001), and more likely to have cancer (19.8% vs. 11.4%, P < 0.0001), or depression (35.1% vs. 30.9%, P < 0.0001). There was marked variability in CD documentation across sites of enrollment (2.8%-24.9%, P < 0.0001). Despite strong associations seen in unadjusted comparisons, in multivariable models many socioeconomic factors, functional status, comorbid illness, and documentation of a surrogate decision maker were only moderately associated with a CD (adjusted odds ratios all less than 2.0). However, patients' site of enrollment (odds ratios 1.74-5.14) and informal notations describing prehospital care wishes (eg, orders for "do not resuscitate"/"do not intubate;" odds ratios 3.22-11.32 compared with no preexisting documentation) were powerfully associated with CD documentation. Site remained a powerful influence even in patients with no documented prehospital wishes. Our results are derived from a relatively small number of academic sites, and we cannot connect documentation differences to differences in patient outcomes. Documentation of a CD at admission was more strongly associated with informal documentation of prehospital care wishes and where the patient was hospitalized than legal care planning documents (such as durable power of attorney), or comorbid illnesses. Efforts to improve communication between hospitalists and their patients might target local documentation practices and culture.

Frequency and Correlates of Advance Planning Among Cognitively Impaired Older Adults

To examine the prevalence and sociodemographic correlates of written advance planning among patients with or at risk for dementia-imposed decisional incapacity. Retrospective, cross-sectional. University-based memory disorders clinic. Persons with a consensus-based diagnosis of mild cognitive impairment (N = 112), probable or possible Alzheimer disease (AD; N = 549), and nondemented comparison subjects (N = 84). N/A. Semistructured interviews to assess durable power of attorney (DPOA) and living will (LW) status upon initial presentation for a dementia evaluation. Sixty-five percent of participants had a DPOA and 56% had a LW. Planning rates did not vary by diagnosis. European Americans (adjusted odds ratio = 4.75; 95% CI, 2.40-9.38), older adults (adjusted odds ratio = 1.05; 95% CI, 1.03-1.07) and college graduates (adjusted odds ratio = 2.06; 95% CI, 1.33-3.20) were most likely to have a DPOA. Findings were similar for LW rates. Although a majority of persons with and at risk for the sustained and progressive decisional incapacity of AD are formally planning for the future, a substantial minority are not.

Planning for End-of-Life Care

The authors examined Black-White differences in the likelihood of completing written advance directives for end-of-life health care and engaging in informal verbal communication about advanced wishes. Data from the 1998 Health and Retirement Study (HRS) were combined with data from the 2000 HRS exit interview to analyze Black and White participants' completion rates. Whites were more likely than Blacks to grant durable power of attorney for health care, to complete a written will, and to informally communicate their wishes; group differences remained after controlling for personal characteristics. Also, Blacks were less likely than Whites to engage in more than one form of end-of-life planning. The authors speculate that sociocultural differences in trust in the medical system and knowledge about advance directives may partially account for these findings. The findings may aid policy makers and practitioners in increasing the level of participation in advance directives.