Low Skepticism and Positive Attitudes About Advance Care Planning Among African Americans: a National, Mixed Methods Cohort Study

Abstract

BACKGROUND: African Americans have low engagement in advance care planning (ACP). This has been attributed to healthcare distrust and skepticism about ACP. A better understanding of these attitudes is needed to address health disparities related to end-of-life care. OBJECTIVE: To explore the ACP-related values and beliefs of diverse African American communities across the USA and then the perceived value of an inexpensive end-of-life conversational game. DESIGN: Prospective, convergent, mixed methods cohort study involving fifteen underserved, African American communities across the USA. PARTICIPANTS: Of the 428 who attended events at purposively sampled sites, 90% consented to the research; 37% participated in one of 15 focus groups (n = 141). INTERVENTION: An end-of-life conversation game, played in groups of 4-6. MAIN MEASURES: The validated, 7-item ACP values and beliefs questionnaire (scaled 7 = least skeptical, 49 = most skeptical) was administered pre-game. Post-game focus groups explored perceptions about ACP and the intervention. KEY RESULTS: Participants had positive attitudes (low skepticism) about ACP with a median score of 12.00 (7.00, 20.00). Values and beliefs did not significantly differ by geographical region; however, rural areas were observed to be slightly more skeptical than urban areas (median score 14.00 vs. 11.00, p = 0.002). Themes from focus groups converged with survey data showing participants valued the ACP process and consider further engagement in ACP to be worthwhile. Subthemes emphasized the need for and value of ACP.CONCLUSIONS: Skepticism about ACP may contribute to low rates of ACP engagement in underserved African American communities. The positive attitudes uncovered in our study either negate previous findings or suggest reduced skepticism. TRIAL REGISTRATION: This study has been registered at clinicaltrials.gov (NCT03456921)

What drives support for social distancing? Pandemic politics, securitization, and crisis management in Britain

“…As shown in Tables 1 and 2, the demographics of age, gender, and ethnicity, produces consistent and statistically significant results that are in line with the expectations derived from the literature. Older people and females are more likely to support government measures (Lancet, 2020) but those from an ethnic minority background are less likely to do so (Van Scoy et al, 2020). Interestingly, key workers are less supportive of social distancing measures, but the effect loses its significance in some models, indicating that variation in support for the lockdown from key workers is contingent on other factors.…”

“…Research indicates that support for social distancing is influenced by multiple factors, but studies have yet to consider the interplay between them to determine their relative explanatory power. Early empirical studies focussed on health-related variables and demographic characteristics to account for behavioural differences between social groups, noting decreased compliance amongst people with low educational attainment and health literacy (Wolf et al, 2020), amongst members of racial/ethnic minorities (Van Scoy et al, 2020), and amongst men and those experiencing health or economic vulnerability (Lancet, 2020). Social psychologists have focused on the influence of personal norms, values, and social identities in driving behaviour (Jetten et al 2020;Wolf et al 2020), which are more susceptible to targeted interventions within a particular societal context compared to demographic factors, as research on climate change has shown (e.g.…”