Factors that Facilitate Informal Advance Care Planning Conversations With Family: A Cross-Sectional Survey of Black Adults With Kidney Failure

Abstract

Background: Advance care planning in adults with kidney failure has been understudied and limited to written advance directives. Many Black adults prefer informal conversations with family, and yet this form of advance care planning is underexplored in research. In this study, we aimed to identify the multilevel factors that facilitate informal advance care planning with family among Black adults with kidney failure. Methods: Black adults with kidney failure were recruited using the electronic health record to identify prospective participants who met inclusion criteria from a metropolitan hospital in the Mid-Atlantic region of the United States from June 2021 to June 2022. Participants completed a survey capturing the personal, interpersonal, and structural level factors that facilitate informal advance care planning conversations with family, and sociodemographic characteristics. Results: The study included 301 respondents, 66% engaged in informal advance care planning and 37% completed an advance directive. Mean age was 56 years, 52% were female, 25% received a high school education or less. Illness acceptance (OR 1.07, P = 0.04) and emotional support (OR 1.44, P = 0.02) facilitated Informal advance care planning, as did having master’s or doctoral level education (OR 2.37, P = 0.04). A recent hospitalization (OR 1.79, P = 0.04) and experience as a surrogate decision maker (OR = 1.76, P = 0.05) also facilitated Informal advance care planning. Conclusions: Informal advance care planning conversations occur more frequently than written directives among Black adults with kidney failure. Future interventions should consider cultural preferences by developing interventions that facilitate informal advance care planning conversations with family.