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Description
Due to the changing demographics, increased attention has been focused on US ethnic minority groups' knowledge about and attitudes toward advance care planning. Research shows that ethnic minority groups are less likely to participate in advance care planning or to complete an advance directive. Increasingly rapid growth in the number and proportion of minority elders has brought more awareness to the racial and ethnic disparities in advance care planning. The United States Congress passed the Patient Self-Determination Act (PSDA) with the purpose of ensuring that individuals' rights to self-determination in health care decisions were communicated and protected with the use of an advance directive. The present study assesses the sociodemographic characteristics of home health and hospice patients in the 2007 National Home Health and Hospice Care Survey and examines the association between predisposing, enabling, and need factors in advance directive completions among home health and hospice patients. The present study utilized Andersen's behavioral model of health service utilization as the theoretical base. It is designed as an analysis of secondary cross-sectional data. Results reveal that patients who were non-minority, male, widowed, enrolled in Medicare or Medicaid, had a primary caregiver, were in a comatose state, had mental impairment, and needed help with eating or feeding were most likely to complete an advance directive. Notably after controlling for predisposing, enabling, and need factors race was significantly associated with advance directive completion. In addition, non-minorities have more positive significant contributing factors linked to the completion of an advance directive than minorities. Furthering our understanding of advance directive completion among minorities will allow for culturally competent modalities to address end-of-life care needs. A collaborative structured and facilitated method can lead to culturally relevant coordination in end-of-life care through the use of an advance directive. Further research should utilize an experimental design, expand on predisposing factors, include a larger minority sample, and include a broader sample of older adults.
