Thomas Jefferson University, Philadelphia, PA, USA.
Am J Hosp Palliat Care. 2024 Feb;41(2):187-192. doi: 10.1177/10499091231173413. Epub 2023 May 9.
Previous studies have noted that participation in advanced care planning (ACP) and end-of-life (EOL) discussions remain low among Latino communities. Various studies have found that interventions within Latino communities can positively improve engagement in ACP, however, minimal research exists regarding patient satisfaction of ACP discussions with healthcare providers outside of preorganized educational interventions. Our study aims to understand how conversations about ACP are perceived by Latino patients in a primary care setting.
Subjects were identified from the institution's family medicine clinic from October 2021 to October 2022. Participants were those over the age of 50 who identified as Latino and were available at the clinic on the day of survey administration. An 8-question, 5-point, Likert scale survey assessed perceptions about ACP planning and gauged satisfaction of conversations with health care providers. The survey concluded with a multiple-choice question inquiring about individuals whom patients have spoken to regarding ACP/EOL wishes. Survey data was gathered through Qualtrics.
Of the 33 patients, the majority have at least thought about their EOL wishes (avg = 3.48/5). Most felt they were given enough time with their doctor (avg = 4.12/5) and comfortable speaking about ACP and EOL decisions (avg = 4.55/5). Generally, participants felt happy with how their doctor has spoken about ACP/EOL care (avg = 3.24/5). However, patients only felt to satisfied with the explanation of ACP/EOL from providers (avg = 2.82/5) and to confident in having the proper forms in place (avg = 2.76/5). Religious officials were to important to these conversations (avg = 2.55/5). Overall, patients have discussed ACP more frequently with family members and friends than health care providers, lawyers, or religious leaders.
The initial data demonstrates that many Latino patients are engaging in ACP conversations, both with healthcare providers and loved ones. Patients largely feel comfortable discussing EOL wishes with their doctor suggesting a trustful relationship. However, patients are only somewhat happy with these ACP conversations. Our study highlights a need for enhanced ACP education to improve satisfaction and confidence in formal documentation. Physicians should continue to engage and individualize ACP discussions to increase EOL preparedness among Latino patients.
先前的研究表明,拉丁裔社区参与预先护理计划(ACP)和生命末期(EOL)讨论的比例仍然很低。许多研究发现,在拉丁裔社区内实施干预措施可以积极提高对 ACP 的参与度,但对于医疗保健提供者在预先组织的教育干预之外与患者进行 ACP 讨论的患者满意度,研究甚少。我们的研究旨在了解 ACP 对话在初级保健环境中是如何被拉丁裔患者感知的。
本研究于 2021 年 10 月至 2022 年 10 月从机构的家庭医学诊所中确定了研究对象。参与者为年龄在 50 岁以上、自认为是拉丁裔且在调查当天在诊所就诊的患者。一项 8 个问题、5 点李克特量表调查评估了对 ACP 规划的看法,并衡量了与医疗保健提供者进行对话的满意度。调查结束时,患者被要求回答一个多项选择题,询问他们与哪些人谈论过 ACP/EOL 意愿。通过 Qualtrics 收集调查数据。
在 33 名患者中,大多数患者至少考虑过他们的 EOL 意愿(平均=3.48/5)。大多数患者认为他们有足够的时间与医生交流(平均=4.12/5),并且在讨论 ACP 和 EOL 决策时感到舒适(平均=4.55/5)。一般来说,患者对医生如何谈论 ACP/EOL 护理感到满意(平均=3.24/5)。然而,患者对提供者对 ACP/EOL 的解释仅感到满意(平均=2.82/5),对适当文件的准备情况仅感到有信心(平均=2.76/5)。宗教官员在这些对话中也很重要(平均=2.55/5)。总体而言,患者与家庭成员和朋友讨论 ACP 的频率高于与医疗保健提供者、律师或宗教领袖。
初步数据表明,许多拉丁裔患者正在与医疗保健提供者和亲人进行 ACP 对话。患者在与医生讨论 EOL 意愿时感到非常舒适,这表明他们之间存在信任关系。然而,患者对这些 ACP 对话仅感到满意。我们的研究强调需要加强 ACP 教育,以提高患者的满意度和对正式文件的信心。医生应该继续参与并个性化 ACP 讨论,以提高拉丁裔患者的 EOL 准备程度。