Implementing an Advance Care Planning Intervention in Community Settings with Older Latinos: A Feasibility Study
Implementing an Advance Care Planning Intervention in Community Settings with Older Latinos: A Feasibility Study
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DOI：
10.1089/jpm.2016.0504
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发表时间：
2017-09-01
影响因子：
2.8
通讯作者：
Mishra, Shiraz I.
中科院分区：
文献类型：
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作者：
Nedjat-Haiem, Frances R.;Carrion, Iraida V.;Mishra, Shiraz I.
背景资料：患有癌症和其他慢性病等严重疾病的老年拉丁美洲人缺乏有关提前护理计划（ACP）的信息。ACP干预（ACP-I计划）的目的是为老年人的信息和沟通需求，以改善沟通和预先指示（AD）。目的：为了确定在新墨西哥州南部患有一种或多种慢性疾病（例如，癌症、心脏病、肾/肝功能衰竭、中风、高血压、糖尿病、慢性阻塞性肺病和HIV/AIDS）。设计：我们通过使用混合数据收集方法进行了一项前瞻性、预测/后测、两组、随机、基于社区的试点试验。设置/受试者：从新墨西哥州南部的基于社区的设置中招募老年拉丁裔/西班牙裔参与者。所有参与者都接受了ACP教育，而干预组增加了：（1）解决心理困扰的情感支持;（2）资源访问的系统导航，所有这些都包括互动式ACP治疗决策支持，并涉及动机访谈（MI）方法。有目的的抽样指导下的社会文化框架，以招募拉丁裔参与者在南部新墨西哥州以社区为基础的设置。样本招募，实施和保留的可行性进行了评估，通过检查以下内容：招募策略，试验招募，保留率，MI咨询的持续时间，访问类型（家庭与电话），并与program.Results的满意度：我们联系了104例患者，招募74随机常规护理39（UC）和治疗35（TX）组。6名在测试后调查前退出，3名在测试后调查前退出，原因是生病（n = 1）或无法找到（n = 2），UC也发生了同样的情况。UC组和TX组的完成率分别为91.4%和92.3%。所有参与者都是拉丁美洲人/西班牙裔，平均在美国出生25年（48%）或墨西哥（51.4%）;大多数是女性，76.5%; 48.6%更喜欢西班牙语; 31.4%的教育程度低于六年级。定性数据表明满意的ACP-I计划intervention.Conclusions：根据招生和干预完成率，完成测试的时间，并从定性研究后的反馈，后续访谈，ACP-I计划被证明是可行的，并认为是非常有帮助的。
Background: Older Latinos with serious medical conditions such as cancer and other chronic diseases lack information about advance care planning (ACP). ACP Intervention (ACP-I Plan) was designed for informational and communication needs of older Latinos to improve communication and advance directives (ADs).Objective: To determine the feasibility of implementing ACP-I Plan among seriously ill, older Latinos (>= 50 years) in Southern New Mexico with one or more chronic diseases (e.g., cancer, heart disease, renal/liver failure, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, and HIV/AIDS).Design: We conducted a prospective, pretest/post-test, two-group, randomized, community-based pilot trial by using mixed data collection methods.Setting/Subjects: Older Latino/Hispanic participants were recruited from community-based settings in Southern New Mexico.Methods: All participants received ACP education, whereas the intervention group added: (1) emotional support addressing psychological distress; and (2) systems navigation for resource access, all of which included interactive ACP treatment decisional support and involved motivational interview (MI) methods. Purposive sampling was guided by a sociocultural framework to recruit Latino participants from community-based settings in Southern New Mexico. Feasibility of sample recruitment, implementation, and retention was assessed by examining the following: recruitment strategies, trial enrollment, retention rates, duration of MI counseling, type of visit (home vs. telephone), and satisfaction with the program.Results: We contacted 104 patients, enrolled 74 randomized to usual care 39 (UC) and treatment 35 (TX) groups. Six dropped out before the post-test survey, three from TXbefore the post-test survey because of sickness (n = 1) or could not be located (n = 2), and the same happened for UC. Completion rates were 91.4% UC and 92.3% TX groups. All participants were Latino/Hispanic, born in the United States (48%) or Mexico (51.4%) on average in the United States for 25 years; majority were female, 76.5%; 48.6% preferred Spanish; and 31.4% had less than sixth-grade education. Qualitative data indicate satisfaction with the ACP-I Plan intervention.Conclusions: Based on enrollment and intervention completion rates, time to completion tests, and feedback from qualitative post-study, follow-up interviews, the ACP-I Plan was demonstrated to be feasible and perceived as extremely helpful.