Exploring Motivational Interviewing to Engage Latinos in Advance Care Planning: A Community-Based Social Work Intervention

Nedjat-Haiem, Frances R.; Carrion, Iraida V.; Gonzalez, Krystyna; Bennett, Elizabeth D.; Ell, Kathleen; O’Connell, Mary; Thompson, Beti; Mishra, Shiraz I.

doi:10.1177/1049909118763796

Cited by 12 publications

(13 citation statements)

References 27 publications

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“…[7][8][9][10][11] Known barriers to ACP include individual (eg, knowledge, attitudes) and health system level (eg, complexity of advance directive forms, lack of clinician training) factors. However, despite development of patient-and provider-facing programs to increase ACP, [12][13][14][15][16][17] overall rates of ACP have not increased appreciably among diverse older adults in the US. 7 ACP is a complex, socially mediated behavior 18,19 ; thus, as with other socially mediated health behaviors, such as physical activity, blood pressure management, and tobacco use, [20][21][22] it is likely that community-level factors influence ACP.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

et al. 2020

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IMPORTANCE Advance care planning (ACP) is low among older adults with socioeconomic disadvantage. There is a need for tailored community-based approaches to increase ACP, but community patterns of ACP are poorly understood. OBJECTIVETo examine the association between neighborhood socioeconomic status (nSES) and ACP and to identify communities with both low nSES and low rates of ACP. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study examined University of California San Francisco electronic health record (EHR) data and place-based data from 9 San Francisco Bay Area counties. Participants were primary care patients aged 65 years or older and living in the San Francisco Bay Area in July 2017. Statistical analysis was performed from May to June 2020. EXPOSURES Patients' home addresses were geocoded and assigned to US Census tracts. The primary factor, nSES, an index combining area-level measures of income, education, poverty, employment, occupation, and housing or rent values, was divided into quintiles scaled to the distribution of all US Census tracts in the Bay Area (Q1 = lowest nSES). Covariates were from the EHR and included health care use (primary care, outpatient specialty, emergency department, and inpatient encounters in the prior year). MAIN OUTCOMES AND MEASURESACP was defined as a scanned document (eg, advance directive), ACP Current Procedural Terminology code, or ACP note type in the EHR. RESULTS There were 13 104 patients included in the cohort-mean (SD) age was 75 (8) years, with 7622 female patients (58.2%), 897 patients (6.8%) identified as Black, 913 (7.0%) as Latinx, 3788 (28.9%) as Asian/Pacific Islander, and 748 (5.7%) as other minority race/ethnicity, and 2393 (18.3%) self-reported that they preferred to speak a non-English language. Of these, 3827 patients (29.2%) had documented ACP. The cohort was distributed across all 5 quintiles of nSES (Q1: 1426 patients

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Section: Introductionmentioning

confidence: 99%

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

et al. 2020

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“…Healthcare providers are tasked with educating patients about ACP. Studies have shown their ability, skills, knowledge, and attitudes influence AD communication and patient education across disciplines 3 in medicine, 4 nursing, 5 and social work. However, multiple barriers, including lack of consideration of patients' values and beliefs, contribute to poor delivery of healthcare information.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Providers’ Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: A National Survey

Nedjat-Haiem

Cadet

Amatya

et al. 2018

Am J Hosp Palliat Care

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Background: Advance care planning for end-of-life care emerged in the mid-1970’s to address the need for tools, such as the advance directive (AD) legal document, to guide medical decision-making among seriously ill patients, their families, and healthcare providers. Objective: Study aims examine providers’ perspectives on AD education that involve examining (1) a range of attitudes about educating patients, (2) whether prior knowledge was associated with practice behaviors in educating patients, and (3) specific factors among healthcare providers such as characteristics of work setting, knowledge, attitudes, and behaviors that may influence AD education and documentation. Design: To examine providers’ views, we conducted a cross-sectional, online survey questionnaire of healthcare providers using social media outreach methods for recruitment. Methods: This study used a cross-sectional survey design to examine the proposed aims. Healthcare providers, recruited through a broad approach using snowball methods, were invited to participate in an online survey. Logistic regression analyses were used to examine providers’ views toward AD education. Results: Of 520 participants, findings indicate that most healthcare providers said that they were knowledgeable about AD education. They also viewed providing education as beneficial to their practice. These findings suggest that having a positive attitude toward AD education and experiencing less organizational barriers indicate a higher likelihood that providers will educate patients regarding ADs. Conclusion: Various disciplines are represented in this study, which indicates that attitudes and knowledge influence AD discussions. The importance of AD discussions initiated by healthcare providers is critical to providing optimal patient-centered care.

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“…Our previous research found Latino culture as important to consider toward avoiding discussions about death and documenting a living will. 19 Additionally, consistent with a cross-sectional study examining Latino preferences for planning and EOL care, participants had not communicated their preferences to family members or their providers. 31 Although Latinos appear to prefer family-centered decision-making for EOL care, they may not want to burden others about distressing issues such as the possibility of dying and preparing for death.…”

Section: Discussionmentioning

confidence: 99%

“…Motivational interviewing counseling used for the intervention involved older Latinos in ACP, targeting their readiness to engage in ACP communication with others (eg, doctors, nurses, and/or family members) and desire to plan for EOL care by documenting an AD. 19 TX group participants receiving MI counseling were guided toward the complex topic of death and dying, allowing them to ask questions about ACP and documenting an AD involving (1) the living will and (2) durable power of attorney for health-care decision-making. Motivational interviewing counseling was delivered by a social worker with an advanced level of education in social work at the master's level.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial

Nedjat-Haiem

Cadet

Amatya

et al. 2019

Am J Hosp Palliat Care

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Background: End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented. Objective: The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members. Methods: We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation. Results: Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects. Conclusion: When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.

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Exploring Motivational Interviewing to Engage Latinos in Advance Care Planning: A Community-Based Social Work Intervention

Abstract: This study contributes to the literature by identifying areas for adaption to enhance understanding and increase information to ultimately achieve the completion of ACP among Latinos.

Cited by 12 publications

References 27 publications

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

Healthcare Providers’ Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: A National Survey

Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial

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