From Barriers to Assets: Rethinking factors impacting advance care planning for African Americans
From Barriers to Assets: Rethinking factors impacting advance care planning for African Americans
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DOI：
10.1017/s147895151800038x
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发表时间：
2019-06-01
影响因子：
2.2
通讯作者：
Sterba, Katherine R.
中科院分区：
文献类型：
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作者：
Sanders, Justin J.;Johnson, Kimberly S.;Sterba, Katherine R.
目的从多角度探讨非裔美国人提前护理计划(ACP)的障碍和促进者，以找出可能具有临床意义的相似或不同之处。方法对健康差异专家(n=5)、社区成员(n=9)和重病非裔美国人患者和照顾者(n=11)进行定性研究。结果受试者确定了影响非裔美国人非裔美国人ACP的七个主要因素：宗教和灵性；信任和不信任；家庭关系和经历；患者和临床医生关系；预后沟通、护理偏好以及准备和控制。这些影响与现有文献中的描述相呼应；然而，我们的数据突出了这些因素对ACP的积极或消极影响程度上按组一致的差异。专家与会者强调了文献中的共同主题，例如，非裔美国人因为不信任和宗教而对预测信息不感兴趣。重病患者更有可能表达对他们的临床医生的信任，并渴望进行预后沟通；他们和社区成员表达了为生命结束做准备和控制的愿望。宗教信仰似乎并没有否定这些愿望。结果的意义非裔美国人中关于非典的文献可能不能准确地反映病情严重的非裔美国人的经历。通常被理解为机场核心计划障碍的东西，实际上可能并非如此。我们建议重建对机场核心计划的刻板印象的障碍，例如宗教和灵性，或家庭，作为文化资产，应该被用来加强机场核心计划。虽然进一步的研究可以为非裔美国人患者参与ACP提供最佳实践，但研究结果表明，尊重和建立融洽的沟通可能会促进ACP。鼓励临床医生使用尊重和融洽的沟通方法，包括开放式问题，参与早期的ACP。
ObjectiveWe aimed to explore multiple perspectives regarding barriers to and facilitators of advance care planning (ACP) among African Americans to identify similarities or differences that might have clinical implications.MethodQualitative study with health disparities experts (n = 5), community members (n = 9), and seriously ill African American patients and caregivers (n = 11). Using template analysis, interviews were coded to identify intrapersonal, interpersonal, and systems-level themes in accordance with a social ecological framework.ResultParticipants identified seven primary factors that influence ACP for African Americans: religion and spirituality; trust and mistrust; family relationships and experiences; patient-clinician relationships; prognostic communication, care preferences, and preparation and control. These influences echo those described in the existing literature; however, our data highlight consistent differences by group in the degree to which these factors positively or negatively affect ACP. Expert participants reinforced common themes from the literature, for example, that African Americans were not interested in prognostic information because of mistrust and religion. Seriously ill patients were more likely to express trust in their clinicians and to desire prognostic communication; they and community members expressed a desire to prepare for and control the end of life. Religious belief did not appear to negate these desires.Significance of resultsThe literature on ACP in African Americans may not accurately reflect the experience of seriously ill African Americans. What are commonly understood as barriers to ACP may in fact not be. We propose reframing stereotypical barriers to ACP, such as religion and spirituality, or family, as cultural assets that should be engaged to enhance ACP. Although further research can inform best practices for engaging African American patients in ACP, findings suggest that respectful, rapport-building communication may facilitate ACP. Clinicians are encouraged to engage in early ACP using respectful and rapport building communication practices, including open-ended questions.