Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.
J Am Geriatr Soc. 2023 Aug;71(8):2601-2614. doi: 10.1111/jgs.18236. Epub 2023 Jan 18.
Advance care planning (ACP) is low among Latinx older adults. We used community-based participatory research (CBPR) to identify ACP barriers/facilitators and design community-based ACP events.
In partnership with community-based organizations, clinicians, and local government, we formed a Latinx Community Committee (n = 13 community members). We then conducted 6 focus groups with Latinx-identifying, English or Spanish-speaking older adults (age ≥ 55), caregivers, and community leaders to assess ACP barriers/facilitators. We analyzed transcripts using thematic analysis and, based on these learnings, designed and implemented community-based ACP events. Using a validated survey, we assessed acceptability and pre-to-post-event ACP readiness (4-point scale; 4 = most ready; 0.2 change considered meaningful) with Wilcoxon signed-rank tests.
Focus groups included 10 Spanish-speaking older adults, 8 caregivers, and 10 community leaders. Themes highlighted the importance of ACP (e.g., means of advocacy), barriers (e.g., how to start conversations), and facilitators (e.g., trusted community spaces) in the Latinx community. Ninety-seven people attended 5 events targeting 3 Latinx populations (LGBTQI+, intergenerational, and older adults broadly). Overall pre-to-post-event ACP readiness increased (2.62 (SD 0.97) to 2.95 (SD 0.93); p = 0.05). Readiness to document wishes increased significantly (2.44 (SD 1.0) to 2.98 (SD 0.95); p = 0.003). Most reported being comfortable attending events (85%) and would recommend them to others (90%).
This study describes a feasible, acceptable, and effective CBPR ACP intervention. Co-developed community events represent a promising approach to reducing disparities in ACP among the Latinx population.
拉丁裔老年人的预先医疗照护计划（ACP）很低。我们使用基于社区的参与性研究（CBPR）来确定 ACP 的障碍/促进因素，并设计基于社区的 ACP 活动。
我们与社区组织、临床医生和当地政府合作，成立了一个拉丁裔社区委员会（n=13 名社区成员）。然后，我们与拉丁裔认同的、讲英语或西班牙语的老年人（年龄≥55 岁）、照顾者和社区领袖进行了 6 次焦点小组讨论，以评估 ACP 的障碍/促进因素。我们使用主题分析对转录本进行了分析，并根据这些学习成果，设计并实施了基于社区的 ACP 活动。使用经过验证的调查，我们使用 Wilcoxon 符号秩检验评估了可接受性和预到后事件 ACP 准备情况（4 分制；4=最准备；0.2 分的变化被认为有意义）。
焦点小组包括 10 名讲西班牙语的老年人、8 名照顾者和 10 名社区领袖。主题突出了 ACP 在拉丁裔社区中的重要性（例如，倡导的手段）、障碍（例如，如何开始对话）和促进因素（例如，可信赖的社区空间）。97 人参加了针对 3 个拉丁裔群体（LGBTQI+、代际和老年人）的 5 个活动。总体而言，预到后事件 ACP 准备情况有所提高（2.62（SD 0.97）到 2.95（SD 0.93）；p=0.05）。记录意愿的准备情况显著增加（2.44（SD 1.0）到 2.98（SD 0.95）；p=0.003）。大多数人表示参加活动感到舒适（85%），并愿意向他人推荐（90%）。
本研究描述了一种可行、可接受和有效的基于社区的 ACP 干预措施。共同制定的社区活动代表了减少拉丁裔人群中 ACP 差异的一种有前途的方法。
