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

项目总结/摘要 提前护理计划（ACP）是一个过程，通过这个过程，成年人分享他们的价值观，目标和偏好， 医疗等它与无数积极的结果相关，包括更高的患者和家庭满意度 与临终关怀和更高的可能性，病人接受照顾符合他们的目标，是至关重要的， 老年人在医疗决策中的自我决定和自主权。然而，ACP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， 健康知识有限，英语能力有限。ACP的障碍包括患者和卫生系统 因素（例如，知识，态度，AD复杂性），但对社区水平的因素知之甚少（例如， 社交网络、物理环境如老年中心）。人们越来越认识到，非加太是一个 社会介导的健康行为;因此，社区层面的因素可能发挥很大作用， 在戒烟或锻炼等其他行为中也表现出来。目前缺乏对 与非加太相关的社区背景阻碍了有效、可扩展和可持续干预措施的设计 这可以有意义地增加非加太国家，也有可能加剧非加太国家的差距。这是特别 关于经历系统性劣势和种族主义的特定社区， 不平等，包括非加太国家。因此，了解与非加太有关的社区背景， 社区一级对非加太的障碍势在必行。在弗朗西斯科（SF），Bayview-Hunters Point是一个低 黑人（30%）和拉丁裔（23%）居民比例较高的社会经济社区 老年居民中ACP的发病率较低。该项目的目的是探索社区- 一级的促进者和障碍，以非加太，并完善和试点测试一个非加太社区工具包在湾景。在 与旧金山残疾和老龄化服务部和旧金山姑息治疗工作组合作， 本建议探讨两个具体目标：1）探讨社区之间的ACP促进因素和障碍， 基于利益攸关方（老年人、护理人员、宗教领袖、个案管理人员、地方行政领导人） 为老年人服务的组织），并在文化上调整和完善非加太社区工具包， 以及为社区人士提供服务;及2）就改良后的机场核心计划进行可行性、接受程度及试验性测试 社区居住老年人的社区工具包。这项工作将产生重大影响， 扩大ACP在弱势老年人中的覆盖面并缩小差距。这项工作将奠定 为最终可适用于其他国家的社区一级公共卫生办法奠定基础 社区和地理位置。

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.