Completion of advance directives among African Americans and Whites adults |
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| Institution: | 1. Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA;2. Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA;3. Department of Public Health, CDU, Los Angeles, CA, USA;4. Physician Assistant Program, CDU, Los Angeles, CA, USA;5. School of Nursing, CDU, Los Angeles, CA, USA;1. Centre for Educational Development, Aarhus University, Health, Aarhus, Denmark;2. Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark;3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;1. National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China;2. Department of Nutrition, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China;3. Department of Epidemiology and Health Statistics, Xiangya school of Public health, Central South University, Changsha, Hunan, China;4. Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China;5. Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China;1. College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia;2. College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia;3. Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia |
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| Abstract: | ObjectiveThe primary purpose of this study was to analyze the completion of advance directives among African American and White adults and examine related factors, including demographics, socio-economic status, health conditions, and experiences with health care providers.MethodsThis study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We compared correlates of completion of advance directives among a sample of 1635 African American and White adults. Multivariate analysis was conducted.ResultsWhites were 50% more likely to complete an advance directive than African Americans. The major differences between African Americans and Whites were mainly explained by the level of mistrust and discrimination experienced by African Americans and partially explained by demographic characteristics. Our study showed that at both bivariate and multivariate levels, participation in religious activities was associated with higher odds of completion of an advance directive for both African Americans and Whites.ConclusionInterventional studies needed to address the impact of mistrust and perceived discrimination on advance directive completion.Practical implicationsCulturally appropriate multifaceted, theoretical- and religious-based interventions are needed that include minority health care providers, church leaders, and legal counselors to educate, modify attitudes, provide skills and resources for communicating with health care providers and family members. |
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| Keywords: | Ethnicity/Race African Americans Discrimination Mistrust Advance directives |
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