Taking Advance Care Planning (ACP) to Diverse Older Adult Communities: Facilitators, Barriers, and Development of a Novel ACP Toolkit

对多元化老年人社区进行预先护理计划 (ACP)：促进因素、障碍和新型 ACP 工具包的开发

• 批准号: 10300924
• 负责人: Sarah Nouri
• 金额: $ 16.15万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10300924
• 关键词: Address; Administrator; Adult; Advance Care Planning; Advanced Development; Aging; Area; Attitude; Award; Behavior; Caregivers; Caring; Case Manager; Censuses; Church; Client; Clinical; Cognitive; Color; Communities; Community Outreach; Data; Decision Making; Development; Diagnosis; Disadvantaged; Discipline; Disease; Elderly; Electronic Health Record; Enrollment; Environment; Ethnic group; Exercise; Face; Family; Feedback; Focus Groups; Fostering; Generations; Geographic Locations; Goals; Health behavior; Health system; Intervention; Knowledge; Latinx; Limited English Proficiency; Link; Low income; Mediating; Medical; Mentors; Methods; Mission; National Institute on Aging; Neighborhoods; Older Population; Outcome; Palliative Care; Patients; Physical environment; Play; Prevention; Process; Public Health; Randomized Controlled Trials; Readiness; Religion and Spirituality; Research; Role; San Francisco; Self Determination; Self Efficacy; Services; Social Environment; Social Network; Socioeconomic Status; Surveys; Testing; Time; Training; Vulnerable Populations; Work; base; common treatment; community organizations; community planning; design; disability; disparity reduction; end of life care; evidence base; experience; health disparity; health literacy; implementation science; improved; low socioeconomic status; member; novel; patient population; preference; programs; racial and ethnic; racism; recruit; satisfaction; smoking cessation; social; socioeconomics; theories; therapy design

PROJECT SUMMARY/ABSTRACT Advance care planning (ACP) is a process by which adults share their values, goals, and preferences for medical care. It is associated with myriad positive outcomes, including higher patient and family satisfaction with end-of-life care and a higher likelihood of patients receiving care consistent with their goals, and is critical for older adults' self-determination and autonomy in medical decision-making. Yet, ACP is as low as 20-30% among older vulnerable populations including people of color and those with lower socioeconomic status, limited health literacy, and limited English proficiency. Barriers to ACP include patient and health system factors (e.g., knowledge, attitudes, AD complexity), but little is known about community-level factors (e.g., social networks, physical environments like senior centers). There is an increasing understanding that ACP is a socially mediated health behavior; therefore, it is likely that community-level factors play a large role, as has been shown in other behaviors like smoking cessation or exercise. The current lack of understanding of the community context as it relates to ACP hinders the design of effective, scalable, and sustainable interventions that can meaningfully increase ACP and also threatens to exacerbate disparities in ACP. This is particularly concerning given communities experiencing systemic disadvantage and racism also face tremendous health disparities, including in ACP. Thus, understanding the community context as it relates to ACP and overcoming community-level barriers to ACP is imperative. In San Francisco (SF), the Bayview-Hunters Point is a low socioeconomic neighborhood with high proportions of residents identifying as Black (30%) and Latinx (23%) and with low rates of ACP among older adult residents. The objective of this proposal is to explore community- level facilitators and barriers to ACP, and to refine and pilot test an ACP Community Toolkit in the Bayview. In partnership with the SF Department of Disability and Aging Services and the SF Palliative Care Workgroup, this proposal investigates two specific aims: 1) to explore ACP facilitators and barriers among community- based stakeholders (older adults, caregivers, religious leaders, case managers, administrative leaders of local organizations serving older adults) and culturally adapt and refine an ACP Community Toolkit to be used by and for community members, and 2) to conduct feasibility, acceptability, and pilot testing of the refined ACP Community Toolkit among community-dwelling older adults. This work will have a significant impact in increasing the reach and reducing disparities of ACP among vulnerable older adults. This work will lay the groundwork of a community-level, public-health approach to ACP that can eventually be applied to other communities and geographic locations.

项目摘要/摘要 高级护理计划(ACP)是成年人分享他们的价值观、目标和偏好的过程 医疗护理。它与无数积极的结果有关，包括更高的患者和家庭满意度 临终关怀和患者接受与其目标一致的护理的可能性更高，这是至关重要的 老年人在医疗决策中的自主权和自主权。然而，非物质文化遗产低至20%-30% 在老年弱势群体中，包括有色人种和社会经济地位较低的人， 健康素养有限，英语水平有限。ACP的障碍包括患者和医疗系统 因素(例如知识、态度、AD复杂性)，但对社区层面的因素知之甚少(例如， 社交网络、老年中心等物理环境)。越来越多的人认识到机场核心工程是一种 社会中介的健康行为；因此，社区层面的因素很可能发挥很大的作用，正如已经发生的那样 在戒烟或锻炼等其他行为中也有表现。目前对这一问题缺乏了解 与机场核心计划相关的社区背景阻碍了有效、可扩展和可持续的干预措施的设计 这可能会有意义地增加非加太，也有可能加剧非加太的差距。这是特别的 关于经历系统性劣势和种族主义的特定社区，也面临着巨大的健康 差异，包括在机场核心计划方面。因此，理解与机场核心计划有关的社区背景并克服 社区层面的障碍是机场核心计划的当务之急。在旧金山(SF)，湾景-亨特斯点是最低的 具有较高比例的黑人(30%)和拉丁裔(23%)居民的社会经济社区 老年居民的ACP患病率较低。这项建议的目的是探讨社区- 提升ACP的促进者和障碍，并在湾视图中完善和试行ACP社区工具包。在……里面 与旧金山残疾和老龄服务部和旧金山姑息治疗工作组合作， 该提案调查了两个具体目标：1)探索机场核心计划的促进者和社区之间的障碍- 以利益相关者为基础(老年人、照顾者、宗教领袖、案件经理、地方行政领导人 为老年人服务的组织)，并在文化上调整和改进ACP社区工具包，以供 和社区成员，以及2)对改进后的机场核心计划进行可行性、可接受性和中试测试 社区居住的老年人的社区工具包。这项工作将对 扩大非物质文化遗产在弱势老年人中的覆盖面并缩小差距。这项工作将为 为机场核心计划的社区级公共卫生方法奠定基础，最终可应用于其他 社区和地理位置。