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"Don't Talk to Them About Goals of Care": Understanding Disparities in Advance Care Planning.

Publication ,  Journal Article
Ashana, DC; D'Arcangelo, N; Gazarian, PK; Gupta, A; Perez, S; Reich, AJ; Tjia, J; Halpern, SD; Weissman, JS; Ladin, K
Published in: J Gerontol A Biol Sci Med Sci
February 3, 2022

BACKGROUND: Structurally marginalized groups experience disproportionately low rates of advance care planning (ACP). To improve equitable patient-centered end-of-life care, we examine barriers and facilitators to ACP among clinicians as they are central participants in these discussions. METHOD: In this national study, we conducted semi-structured interviews with purposively selected clinicians from 6 diverse health systems between August 2018 and June 2019. Thematic analysis yielded themes characterizing clinicians' perceptions of barriers and facilitators to ACP among patients, and patient-centered ways of overcoming them. RESULTS: Among 74 participants, 49 (66.2%) were physicians, 16.2% were nurses, and 13.5% were social workers. Most worked in primary care (35.1%), geriatrics (21.1%), and palliative care (19.3%) settings. Clinicians most frequently expressed difficulty discussing ACP with certain racial and ethnic groups (African American, Hispanic, Asian, and Native American) (31.1%), non-native English speakers (24.3%), and those with certain religious beliefs (Catholic, Orthodox Jewish, and Muslim) (13.5%). Clinicians were more likely to attribute barriers to ACP completion to patients (62.2%), than to clinicians (35.1%) or health systems (37.8%). Three themes characterized clinicians' difficulty approaching ACP (preconceived views of patients' preferences, narrow definitions of successful ACP, and lack of institutional resources), while the final theme illustrated facilitators to ACP (acknowledging bias and rejecting stereotypes, mission-driven focus on ACP, and acceptance of all preferences). CONCLUSIONS: Most clinicians avoided ACP with certain racial and ethnic groups, those with limited English fluency, and persons with certain religious beliefs. Our findings provide evidence to support development of clinician-level and institutional-level interventions and to reduce disparities in ACP.

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Published In

J Gerontol A Biol Sci Med Sci

DOI

EISSN

1758-535X

Publication Date

February 3, 2022

Volume

77

Issue

2

Start / End Page

339 / 346

Location

United States

Related Subject Headings

  • White People
  • Terminal Care
  • Religion
  • Physician-Patient Relations
  • Humans
  • Hispanic or Latino
  • Gerontology
  • Communication
  • Black or African American
  • Asian
 

Citation

APA
Chicago
ICMJE
MLA
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Ashana, D. C., D’Arcangelo, N., Gazarian, P. K., Gupta, A., Perez, S., Reich, A. J., … Ladin, K. (2022). "Don't Talk to Them About Goals of Care": Understanding Disparities in Advance Care Planning. J Gerontol A Biol Sci Med Sci, 77(2), 339–346. https://doi.org/10.1093/gerona/glab091
Ashana, Deepshikha Charan, Noah D’Arcangelo, Priscilla K. Gazarian, Avni Gupta, Stephen Perez, Amanda J. Reich, Jennifer Tjia, Scott D. Halpern, Joel S. Weissman, and Keren Ladin. “"Don't Talk to Them About Goals of Care": Understanding Disparities in Advance Care Planning.J Gerontol A Biol Sci Med Sci 77, no. 2 (February 3, 2022): 339–46. https://doi.org/10.1093/gerona/glab091.
Ashana DC, D’Arcangelo N, Gazarian PK, Gupta A, Perez S, Reich AJ, et al. "Don't Talk to Them About Goals of Care": Understanding Disparities in Advance Care Planning. J Gerontol A Biol Sci Med Sci. 2022 Feb 3;77(2):339–46.
Ashana, Deepshikha Charan, et al. “"Don't Talk to Them About Goals of Care": Understanding Disparities in Advance Care Planning.J Gerontol A Biol Sci Med Sci, vol. 77, no. 2, Feb. 2022, pp. 339–46. Pubmed, doi:10.1093/gerona/glab091.
Ashana DC, D’Arcangelo N, Gazarian PK, Gupta A, Perez S, Reich AJ, Tjia J, Halpern SD, Weissman JS, Ladin K. "Don't Talk to Them About Goals of Care": Understanding Disparities in Advance Care Planning. J Gerontol A Biol Sci Med Sci. 2022 Feb 3;77(2):339–346.
Journal cover image

Published In

J Gerontol A Biol Sci Med Sci

DOI

EISSN

1758-535X

Publication Date

February 3, 2022

Volume

77

Issue

2

Start / End Page

339 / 346

Location

United States

Related Subject Headings

  • White People
  • Terminal Care
  • Religion
  • Physician-Patient Relations
  • Humans
  • Hispanic or Latino
  • Gerontology
  • Communication
  • Black or African American
  • Asian