Community-Based Advance Care Planning Interventions for Minority Older Adults: A Systematic Review.
Leah V Estrada, Catherine C Cohen, Jingjing Shang and 1 others
PMID 34039091WHAT IT FOUND
Bilingual community programs increased advance directive completion and planning discussions, but motivational interviewing reduced intention to discuss planning.
Evidence came from five fair-to-good studies.
Key findings
01A bilingual, nurse-led seminar at a Chinese community center produced a 20% increase in advance directive completion one month later among participants who had none.
02Hispanic participants randomized to advance care planning education plus motivational interviewing had higher odds of advance directive completion than education alone (OR = 6.901; p < 0.05).
03In the same randomized Hispanic study, adding motivational interviewing reduced intention to engage in advance care planning discussions compared with education alone.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only five studies met inclusion criteria, and no meta-analysis was possible because the studies were heterogeneous and few. Quality scores ranged from 14 to 21, and four of five studies were rated fair. Several studies used convenience sampling, and blinding of participants or outcome assessors was not reported. The review included only English-language U.S. studies and excluded grey literature, caregiver or family studies, and studies that included non-Hispanic White participants. No interventions designed for or implemented among African American older adults were identified. Included study participants had mean ages from 61 to 73.5 years and most were female. The randomized Hispanic study found a negative effect on intention to discuss planning, so the results were not uniformly positive.
The easy way to misread this
Do not read this review as proof that motivational interviewing helps all advance care planning outcomes. It increased the likelihood of advance directive completion in a randomized study, but reduced intention to engage in advance care planning discussions compared with education alone.