Nedjat-Haiem Frances R, Carrion Iraida V, Gonzalez Krystyna, Quintana Alejandra, Ell Kathleen, O'Connell Mary, Thompson Beti, Mishra Shiraz I
1 School of Social Work, New Mexico State University , Las Cruces, New Mexico .
2 School of Social Work, University of South Florida , Tampa, Florida.
J Palliat Med. 2017 Sep;20(9):984-993. doi: 10.1089/jpm.2016.0504. Epub 2017 May 3.
Older Latinos with serious medical conditions such as cancer and other chronic diseases lack information about advance care planning (ACP). ACP Intervention (ACP-I Plan) was designed for informational and communication needs of older Latinos to improve communication and advance directives (ADs).
To determine the feasibility of implementing ACP-I Plan among seriously ill, older Latinos (≥50 years) in Southern New Mexico with one or more chronic diseases (e.g., cancer, heart disease, renal/liver failure, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, and HIV/AIDS).
We conducted a prospective, pretest/post-test, two-group, randomized, community-based pilot trial by using mixed data collection methods.
SETTING/SUBJECTS: Older Latino/Hispanic participants were recruited from community-based settings in Southern New Mexico.
All participants received ACP education, whereas the intervention group added: (1) emotional support addressing psychological distress; and (2) systems navigation for resource access, all of which included interactive ACP treatment decisional support and involved motivational interview (MI) methods. Purposive sampling was guided by a sociocultural framework to recruit Latino participants from community-based settings in Southern New Mexico. Feasibility of sample recruitment, implementation, and retention was assessed by examining the following: recruitment strategies, trial enrollment, retention rates, duration of MI counseling, type of visit (home vs. telephone), and satisfaction with the program.
We contacted 104 patients, enrolled 74 randomized to usual care 39 (UC) and treatment 35 (TX) groups. Six dropped out before the post-test survey, three from TX before the post-test survey because of sickness (n = 1) or could not be located (n = 2), and the same happened for UC. Completion rates were 91.4% UC and 92.3% TX groups. All participants were Latino/Hispanic, born in the United States (48%) or Mexico (51.4%) on average in the United States for 25 years; majority were female, 76.5%; 48.6% preferred Spanish; and 31.4% had less than sixth-grade education. Qualitative data indicate satisfaction with the ACP-I Plan intervention.
Based on enrollment and intervention completion rates, time to completion tests, and feedback from qualitative post-study, follow-up interviews, the ACP-I Plan was demonstrated to be feasible and perceived as extremely helpful.
患有癌症和其他慢性病等严重疾病的老年拉丁裔缺乏有关预先护理计划（ACP）的信息。ACP干预计划（ACP-I计划）旨在满足老年拉丁裔的信息和沟通需求，以改善沟通和预先医疗指示（AD）。
确定在新墨西哥州南部患有一种或多种慢性病（如癌症、心脏病、肾衰竭/肝功能衰竭、中风、高血压、糖尿病、慢性阻塞性肺疾病和艾滋病毒/艾滋病）的重病老年拉丁裔（≥50岁）中实施ACP-I计划的可行性。
我们采用混合数据收集方法进行了一项前瞻性、测试前/测试后、两组、随机、基于社区的试点试验。
设置/受试者：从新墨西哥州南部的社区环境中招募老年拉丁裔/西班牙裔参与者。
所有参与者都接受了ACP教育，而干预组还增加了：（1）针对心理困扰的情感支持；（2）获取资源的系统导航，所有这些都包括交互式ACP治疗决策支持并采用了动机性访谈（MI）方法。目的抽样以社会文化框架为指导，从新墨西哥州南部的社区环境中招募拉丁裔参与者。通过检查以下方面评估样本招募、实施和保留的可行性：招募策略、试验入组、保留率、MI咨询的持续时间、访视类型（家访与电话访视）以及对该计划的满意度。
我们联系了104名患者，招募了74名患者并随机分为常规护理组39人（UC）和治疗组35人（TX）。6人在测试后调查前退出，TX组有3人在测试后调查前退出，其中1人因病退出，2人无法联系到，UC组情况相同。UC组和TX组的完成率分别为91.4%和92.3%。所有参与者均为拉丁裔/西班牙裔，平均在美国出生（48%）或墨西哥出生（51.4%），在美国平均居住25年；大多数为女性，占76.5%；48.6%更喜欢西班牙语；31.4%的教育程度低于六年级。定性数据表明对ACP-I计划干预感到满意。
根据入组率和干预完成率、完成测试的时间以及定性研究后的反馈、后续访谈，证明ACP-I计划是可行的，并且被认为非常有帮助。
