Advance care planning among African American patients on haemodialysis and their end-of-life care preferences.
Daniel Ahn, Shellie Williams, Nicole Stankus and 1 others
PMID 33616278WHAT IT FOUND
Most African American patients on haemodialysis had never discussed end-of-life care with a provider.
Many saw life as worth living, but dependence and disability were least acceptable, and prior end-of-life discussions were associated with less agreement that life-extending treatment is always wrong.
Key findings
0168.3% of 101 patients reported never having an end-of-life care discussion with a healthcare provider since starting haemodialysis.
02Patients said increased dependence or disability was the least acceptable scenario: 31.7% reported it was not worth living, compared with 20.8% for cognitive decline, 19% for severe discomfort or pain, and 19.8% for burden to family.
03Prior end-of-life discussions with a healthcare provider or family were associated with lower odds of agreeing that it is wrong to withhold or withdraw life-extending treatments.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was African American patients from three units of one national dialysis chain on the South Side of Chicago, so findings may not apply to other groups or settings. Advance care planning documents were not checked in medical records, and patients may have misunderstood or forgotten prior discussions. Patients responded to hypothetical illness scenarios, so their answers may not show how they would choose in real illness. The ACP workbook scenarios were not validated in an African American population, and their psychometric properties were not publicly available. The survey reported associations at one time point and did not test whether end-of-life discussions changed preferences.
Declared interests
The authors declared no relevant financial interests or other conflicts of interest.
The easy way to misread this
Do not read the association between prior end-of-life discussions and less agreement that life-extending treatment is always wrong as proof that advance care planning changes preferences. This survey did not test an intervention, and patients who had discussed end-of-life care may have differed in other ways before the discussions.