Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan.
Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan.
J Pain Symptom Manage. 2021 Jul;62(1):e4-e9. doi: 10.1016/j.jpainsymman.2021.02.029. Epub 2021 Feb 27.
Advance care planning (ACP) is underutilized, especially among Black Americans. Yet, no ACP interventions have been tested at the community level.
Within an established academic and community partnership, we sought to determine whether ACP is a community-identified need and if so, to conduct a pilot study of an evidence-based ACP program, PREPARE (PrepareForYourCare.org).
We conducted open discussions and in-depth interviews to determine the relevance of ACP to the community. We then conducted a pre- to 3-week postpilot study of a virtual peer facilitated brief session to introduce ACP and encourage participants to engage with PREPARE. We conducted thematic content analysis for qualitative data and used paired t-tests to assess within-participant changes in the validated ACP Engagement Survey measured on a 1-5 scale (5 = greatest engagement).
We conducted two discussion groups with community leaders (n = 12) and key informant interviews (n = 6), including leaders in aging, public health, health care and faith. We concluded that ACP is a community priority. In the pilot study, we enrolled 13 Black Americans; 85% were women and the mean age was 59.7 years (SD 15.1). There was a trend toward increased ACP engagement after the peer facilitated PREPARE (mean 3.2 (SD 0.6) pre vs. 3.5 (SD 0.6) post, paired t-test P = 0.06). All participants found the intervention to be acceptable and were satisfied with it.
Community members identified ACP as important for their community. Peer facilitated PREPARE program is a promising community-based strategy to increase engagement in ACP and may promote health equity.
预先医疗照护计划（ACP）的利用率较低，尤其是在非裔美国人中。然而，目前还没有在社区层面上测试过任何 ACP 干预措施。
在一个已建立的学术和社区伙伴关系中，我们试图确定 ACP 是否是社区确定的需求，如果是，我们是否可以对基于证据的 ACP 计划 PREPARE（PrepareForYourCare.org）进行试点研究。
我们进行了公开讨论和深入访谈，以确定 ACP 与社区的相关性。然后，我们对一项虚拟同伴促进的简短介绍性 ACP 方案进行了预至 3 周的试点后研究，并鼓励参与者使用 PREPARE。我们对定性数据进行了主题内容分析，并使用配对 t 检验评估了在经过验证的 ACP 参与度调查中参与者的 1-5 分制（5 分表示最大参与度）的得分变化。
我们与社区领袖（n=12）进行了两次讨论小组会议，并进行了关键知情人访谈（n=6），包括老龄化、公共卫生、医疗保健和信仰方面的领袖。我们得出的结论是，ACP 是社区的首要任务。在试点研究中，我们招募了 13 名非裔美国人；85%为女性，平均年龄为 59.7 岁（标准差 15.1）。在接受同伴促进的 PREPARE 后，ACP 的参与度呈上升趋势（平均 3.2（标准差 0.6）前 vs. 3.5（标准差 0.6）后，配对 t 检验 P=0.06）。所有参与者都认为干预措施是可以接受的，并对其感到满意。
社区成员认为 ACP 对他们的社区很重要。同伴促进的 PREPARE 方案是一种有前途的基于社区的策略，可以提高 ACP 的参与度，并可能促进健康公平。
