Kimpel Christine C, Frechman Erica, Chavez Lorely, Maxwell Cathy A
Vanderbilt University School of Nursing (C.C.K., L.C.), Nashville, Tennessee, USA.
Wake Forest University School of Medicine (E.F.), Wake Forest, North Carolina, USA.
J Pain Symptom Manage. 2025 Jan;69(1):e46-e52. doi: 10.1016/j.jpainsymman.2024.09.018. Epub 2024 Sep 24.
Older adults with low socioeconomic status (SES) participate in advance care planning (ACP) at lower rates than those with higher SES. Community feedback is an essential component of intervention design for communities with fewer social and health resources to ensure that the intervention is relevant and meaningful.
To understand the perspectives for potential interventions, we aimed to qualitatively explore participant priorities for ACP intervention development.
Using a qualitative descriptive design, we recruited and conducted individual and one-time, semi-structured interviews with older adults (aged 50+) with low income (< $20,000/year) (n = 20), Recruitment methods included flyers and in-person recruitment and purposive and snowball sampling methods. Following a thematic analysis plan, themes emerged from recursive transcript review by two independent coders and inductive categorization of the most robust codes.
Two themes captured participants' perspectives regarding ACP intervention development: 1) specialist advocacy and reliability and 2) person-centered communication. Older adults with low SES prioritize ACP communication that is driven by their goals and that is led by trustworthy specialists that advocate for their needs.
Our work highlights that intervention preferences were informed by the prior strain and struggle of waiting on other kinds of health and social services. We propose an adapted model for community research collaboration to promote equity in addition to practice and policy recommendations.
社会经济地位（SES）较低的老年人参与预先护理计划（ACP）的比例低于SES较高的老年人。社区反馈是为社会和健康资源较少的社区设计干预措施的重要组成部分，以确保干预措施具有相关性和意义。
为了解潜在干预措施的观点，我们旨在定性探索老年人对ACP干预措施发展的优先事项。
采用定性描述性设计，我们招募了年收入低于20,000美元的50岁及以上低收入老年人（n = 20），并进行了一次性的半结构化个人访谈。招募方法包括传单、亲自招募以及立意抽样和滚雪球抽样方法。按照主题分析计划，通过两名独立编码员对转录本进行递归审查以及对最有力的编码进行归纳分类，得出了主题。
两个主题体现了参与者对ACP干预措施发展的观点：1）专家倡导与可靠性和2）以人为本的沟通。社会经济地位较低的老年人将由他们的目标驱动且由值得信赖的专家主导、倡导他们需求的ACP沟通作为优先事项。
我们的工作强调，干预偏好受到此前在等待其他类型健康和社会服务时所经历的压力和困难的影响。除了实践和政策建议外，我们还提出了一种适用于社区研究合作的模式，以促进公平。
