Adjunct Professor University of Tennessee, United States
Overview: People who are Black and African American are at a substantial disadvantage when it comes to healthcare and end-of-life planning, and our current initiatives are insufficient. This paper offers the results of a systematic review that explores end-of-life planning and SES-related barriers among people who are Black and African American.Proposal text: People who are Black and African American are at a substantial disadvantage when it comes to healthcare, and our current initiatives are insufficient. Rooted in systems of racism, inequality and mistrust, healthcare disparities in the United States continue to be alarming. Among all racial or ethnic groups in the United States, adults who are Black or African American have the highest rates of mortality and are less likely to complete advance directives and engage in end-of-life planning. As life expectancy has increased among all races in the United States over recent decades, people who are Black or African American need the ability to have a quality end-of-life experience that is not a burden to themselves or their families. Further, minorities have less access to and knowledge about resources available due to being displaced in lower income communities and restricted education regarding necessary end-of-life planning. Social workers must seek to understand the factors that facilitate and provide barriers to quality end-of-life preparation among this disadvantaged population in order to employ critical initiatives to reduce these healthcare disparities and dismantle the systems rooted in racism. Therefore, the purpose of this systematic review is: 1) to explore the extent to which socioeconomic status impacts advance or end-of-life care planning among people who are Black or African American; 2) to ascertain which key people are most involved (i.e., families, friends, healthcare providers); and 3) to identify specific barriers related to SES that might inform treatment planning and policy reform. Method Authors first searched the following databases: CINHAL, PsycINFO, PubMed, SCOPUS, and Social Work Abstracts. The following search strings were used: “Black” OR “African American” AND “Socioeconomic Status” OR “SES” AND “Advance care plan*” OR “end-of-
life care plan*”. To be included, studies must have been: conducted in the United States, an original peer-reviewed research article reporting on outcomes related to end-of-life planning and SES, and conducted with samples that included adults who were Black or African American. The initial search yielded 313 articles. After a multistep screening process, 11 studies met inclusion criteria. Results and Conclusions Three themes emerged from the systematic review among people who are Black or African American: 1) they are more likely to engage in “informal” end-of-life planning; 2) the family system is at the center of the decision-making process; and 3) they are more likely to pursue life- sustaining treatments. Additionally, several of the included articles unpacked key factors associated with SES that can be used to inform culturally sensitive treatment planning and policy reform. Future work and research is needed on end-of-life planning among people who are Black and African American in rural communities. Also, there is a need for future research to specifically address the family dynamics and cultural implications in the Black and African American community for implementation of culturally sensitive end-of-life care planning. Nonetheless, the results of this systematic review offer social work practitioners important culturally sensitive clinical factors that should be taken into consideration when addressing the healthcare inequity gap among this vulnerable population.
