PhD student University of Maryland Baltimore Baltimore, Maryland, United States
Overview: Individuals’ knowledge about a loved one’s end-of-life medical care wishes is predictive of their own ACP engagement. This may provide an unique opportunity for social workers who work with families in end-of-life care settings (e.g., hospice, palliative care, and bereavement) to engage individuals – other than patients – in ACP.Proposal text: Background Patients who have not previously stated their treatment preferences may receive unwanted, costly medical interventions, which can also burden family members with difficult decisions. Despite proven positive outcomes of Advance Care Planning (ACP) in improving both patient and family quality of life, it is still insufficiently utilized. Only 37% US adults have a complete advance directive (Kuldeep et al., 2017). Existing studies primarily examined factors associated with patients’ ACP engagement (e.g., age, gender, race, marital status and health status) but very few explored predictors of ACP among patients’ family or caregivers who experienced the death of a loved one. The goal of this study is to fill in this gap by examining whether the knowledge about a loved one’s end of life care preferences is associated with individual’s ACP engagement.
Sample Data are from the US arm of the Four-Country Survey on Aging and End-of-Life Medical Care. Using probability sampling procedures, phone interviews were conducted to solicit public attitudes and experiences regarding EOL issues. The final analytic sample was Nf609 adults who experienced the death of a family or close friend in the past 5 years.
Measurements Dependent variables are three facets of advance care planning behaviors. Using 2-point responses (yes=1; no=0), participants indicated whether they have had a serious conversation about their EOL wishes about medical care with loved ones (DV 1) or doctors (DV 2), and whether they had documented these wishes (DV 3). Independent variable is measured by a single item asking participants their knowledge about their EOL treatment wishes (Had a pretty good idea or better = 1; No idea or not sure = 0).
Analysis Three logistic regression models were used to explore the association between individuals’ knowledge about a loved one’s EOL medical care wishes and their different levels of ACP behavior.All models were adjusted for age, gender, race, self-rated health, marital status, and education level.
Results In Model 1& 2, individuals who had a greater knowledge about their loved one’s EOL treatment wishes are twice likely to have had a conversation with family about their own EOL wishes and documented wishes than those who didn’t (OR=2.32, P < 0.001; OR=2.03, P < 0.05). In Model 3, no statistically significant association was found between individual’s knowledge about a loved one’s EOL medical care wishes and having conversation with doctors about their own EOL medical preferences.
Implications Using national data, we found that an individual's knowledge about a loved one’s EOL medical care wishes was predictive of two facets of ACP, specifically, having conversations with family about their own EOL medical wishes and having those documented. Social workers who work with families in end-of-life care settings (e.g., hospice, palliative care, and bereavement) may have a unique opportunity to engage individuals – other than patients – in ACP. Focusing their experience of involvement in a loved one’s EOL care may be an effective strategy to enhance ACP engagement. Future research may further explore caregivers’ utilization rate of ACP and its potential positive outcomes in reducing their stress.
