The association between the number of chronic health conditions and advance care planning varies by race/ethnicity
The association between the number of chronic health conditions and advance care planning varies by race/ethnicity
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DOI：
10.1080/13607863.2018.1533521
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发表时间：
2020-03-03
影响因子：
3.4
通讯作者：
Kim, Giyeon
中科院分区：
文献类型：
--
作者：
Choi, Shinae;McDonough, Ian M.;Kim, Giyeon
目的：尽管全国一致认为需要提高所有成年人的提前护理计划（ACP）率，但ACP的种族/民族差异一直存在。这项研究调查了美国中年和老年人中ACP的种族/民族差异和慢性健康状况数量的交叉点。方法：来自2014年健康与退休研究浪潮的8，926名成年人的回答进入多层次逻辑回归分析，采用广义线性混合模型预测ACP专注于分配持久的医疗保健委托书（DPOAHC），并在调整协变量后拥有书面生活意愿。结果：我们发现一个显着的正相关关系，慢性健康状况和ACP的数量。非西班牙裔黑人/非裔美国人和西班牙裔人参与ACP的可能性低于非西班牙裔白人/高加索人。在完成生前遗嘱方面，种族/民族差异甚至更为明显。通过分配DPOAHC和生前遗嘱，慢性健康状况的数量对西班牙裔美国人的影响大于非西班牙裔白人/高加索人对ACP的影响。随着慢性健康状况数量的增加，没有慢性健康状况的西班牙裔美国人之间ACP的初始差异有所下降。结论：我们的研究结果表明，更多的慢性健康状况增加的可能性，西班牙裔将完成ACP文件。应向研究人员、政策制定者和医疗保健专业人员强调这些ACP差异，以减少ACP中明显的种族/民族差异。在个人和家庭参与ACP时，应考虑采取全面和照顾文化的决策方法。
Objectives: Although a national consensus exists on the need to increase the rates of advance care planning (ACP) for all adults, racial/ethnic differences in ACP have been consistently observed. This study investigated the intersection of racial/ethnic differences and the number of chronic health conditions on ACP among middle-aged and older adults in the United States. Method: Responses from 8,926 adults from the 2014 wave of the Health and Retirement Study were entered into multilevel hierarchical logistic regression analyses with generalized linear mixed models to predict ACP focused on assigning a durable power of attorney for healthcare (DPOAHC) and having a written living will after adjusting for covariates. Results: We found a significant positive relationship between the number of chronic health conditions and ACP. Non-Hispanic Blacks/African Americans and Hispanics were less likely to engage in ACP than non-Hispanic Whites/Caucasians. Racial/ethnic disparities were even starker for completing a living will. The number of chronic health conditions had a greater effect for Hispanics than non-Hispanic Whites/Caucasians on ACP through assigning a DPOAHC and having a living will. The initial disparity in ACP among Hispanics with no chronic health conditions decreased as the number of chronic health conditions increased. Conclusion: Our findings suggest that more chronic health conditions increase the likelihood that Hispanics will complete ACP documents. These ACP differences should be highlighted to researchers, policymakers, and healthcare professionals to reduce stark racial/ethnic disparities in ACP. A comprehensive and culturally caring decision-making approach should be considered when individuals and families engage in ACP.