Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
WISE Health, San Francisco, CA, USA.
J Gen Intern Med. 2023 Aug;38(11):2478-2485. doi: 10.1007/s11606-023-08134-2. Epub 2023 Mar 9.
People identifying as Black/African American are less likely to engage in advance care planning (ACP) compared to their White peers, despite the association of ACP with improved patient and caregiver outcomes.
Assess facilitators/barriers to ACP in the San Francisco (SF) Black community and co-design/implement/test community-based ACP pilot events.
Community-based participatory research, including qualitative research, intervention development, and implementation.
In partnership with the SF Palliative Care Workgroup (which includes health system, city, and community-based organizations), we formed an African American Advisory Committee (n = 13). We conducted 6 focus groups with Black older adults (age ≥ 55), caregivers, and community leaders (n = 29). The Advisory Committee then selected 5 community-based organizations through a widespread request for proposal. These community-based organizations designed and implemented community-based pilot events to support ACP engagement.
Two authors analyzed recorded focus group transcripts using thematic analysis. We assessed pre- vs post-event readiness to engage in ACP (validated ACP Engagement Survey; 1-4 scale, 4 = most ready) using Wilcoxon signed rank tests and assessed event acceptability with open-ended questions.
Themes included the importance of ACP to the Black community (sub-themes: strengthens families; preserves dignity, particularly for sexual/gender minorities; is tied to financial planning) and facilitators for increasing ACP engagement (sub-themes: culturally relevant materials; events in trusted community spaces including Black-owned businesses). A total of 114 participants attended 5 events; 74% identified as Black, and 16% as sexual/gender minorities. Readiness to engage in ACP was similar pre- vs post-events; 98% would recommend the events to others.
Community-based ACP events designed and led by and for the Black community are highly acceptable. Novel insights underscored the importance of financial planning as part of ACP and the role of Black-owned businesses as trusted spaces for ACP-related discussions.
与白人同行相比，自称为黑人/非裔美国人的人不太可能参与预先护理计划 (ACP)，尽管 ACP 与改善患者和护理人员的结果有关。
评估旧金山 (SF) 黑人社区中 ACP 的促进因素/障碍，并共同设计/实施/测试基于社区的 ACP 试点活动。
包括定性研究、干预措施制定和实施的基于社区的参与性研究。
与旧金山姑息治疗工作组（包括卫生系统、城市和社区组织）合作，我们成立了一个非裔美国人顾问委员会（n=13）。我们与 29 名黑人老年人（年龄≥55 岁）、护理人员和社区领袖进行了 6 次焦点小组讨论。顾问委员会通过广泛的提案请求选择了 5 个基于社区的组织。这些基于社区的组织设计并实施了基于社区的试点活动，以支持 ACP 的参与。
两位作者使用主题分析分析了记录的焦点小组转录本。我们使用 Wilcoxon 符号秩检验评估了预先和事后参与 ACP 的准备情况（经过验证的 ACP 参与调查；1-4 分制，4=最准备就绪），并使用开放式问题评估了活动的可接受性。
主题包括 ACP 对黑人社区的重要性（子主题：加强家庭；维护尊严，特别是对性/性别少数群体；与财务规划有关）和增加 ACP 参与度的促进因素（子主题：文化相关材料；在值得信赖的社区空间举行的活动，包括黑人拥有的企业）。共有 114 名参与者参加了 5 次活动；74%的人自认为是黑人，16%的人是性/性别少数群体。预先和事后参与 ACP 的准备情况相似；98%的人会向他人推荐这些活动。
由黑人社区设计和领导的基于社区的 ACP 活动非常受欢迎。新的见解强调了财务规划作为 ACP 一部分的重要性，以及黑人拥有的企业作为 ACP 相关讨论的可信赖空间的作用。
