Promoting Advance Directive Completion Among Hispanics: An EBP Project
To promote completion of advance directives (AD) by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) in a Hispanic population through culturally appropriate interventions.
Background
Hispanics utilize more aggressive medical treatment at the end-of-life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites (Agency for Health Research and Quality, 2012; Hanchate, Kronman, Young-Xu, Ash, & Emanuel, 2009). However, the majority of Hispanics would prefer comfort care measures rather than life-prolonging treatment if seriously ill (Kelly, Wenger, and Sarkisian, 2010). Such contradiction is reinforced by the fact that Hispanics are less likely than nonHispanic Whites to have an AD (Carr, 2011; Lake Research Partners & Coalition for Compassionate Care of California, 2012). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending.
Best Practice
The project was implemented with a Hispanic religious congregation. General invitations to participate were made by way of Sunday bulletin announcements, informational flyers, and weekly announcements during general Sunday meetings. Twenty-four participants attended the initial group session. Two group sessions were held at the congregation’s meetinghouse. A folder with printed informational handouts and exercises was provided to each participant along with an initial knowledge and attitudes questionnaire. Sessions included information on the history, legal background, and the basics of ADs. Individual reflections and group exercises were used to explore personal views, ways to talk to loved ones about ACP, and how to make difficult healthcare decisions. At the conclusion of the second group session, the same knowledge and attitude questionnaire was completed. Participants then scheduled a one-on-one session to complete an AD.
Outcomes
Of the 21 eligible participants, 13 attended both group sessions and scheduled a one-on-one visit. Mean scores for knowledge increased from 71% to 91%; mean attitude and comfort scores increased from 61% to 80%; and 100% of participants who attended both group sessions completed an AD.
Implications
Increasing AD completion among Hispanics can be achieved through culturally appropriate interventions that increase knowledge about, attitudes toward, and comfort with end-of-life decisions. Promoting completion of ADs can improve care outcomes and decrease costs. More studies are needed among Hispanics that focus on effective interventions to complete ADs, rather than Hispanic end-of-life cultural preferences alone.