Completion of advance directives among African Americans and Whites adults.
Mohsen Bazargan, Sharon Cobb, Shervin Assari
PMID 33840551WHAT IT FOUND
African American adults reported lower written advance directive completion than White adults, and provider mistrust was associated with lower completion among African Americans. 50% of respondents had not discussed end-of-life wishes with a chosen decision-maker.
Key findings
01African Americans reported written advance directive completion at 33%, compared with 47% of Whites.
02Among African Americans, mistrust of current providers was associated with lower odds of completing an advance directive, while higher perceived racial and insurance/income-based discrimination was associated with higher odds.
0350% of respondents reported not having discussed their end-of-life treatment wishes with the person they wanted to make decisions for them if they could not make their own decisions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a cross-sectional survey, so it cannot show that mistrust, discrimination, age, income, or religious attendance caused advance directive completion. Advance directive status, discrimination, and trust were self-reported, so responses may be biased or inaccurate. The sample was limited to California adults recruited through an online panel, with supplemental nonprobability sampling for African Americans, so it may not represent other states or populations. The paper did not examine health literacy, cultural sensitivity, readability, or availability of advance directive forms, which may affect completion.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that African American adults have lower completion because of race/ethnicity; after controlling for other variables, race/ethnicity showed no main effect, and this cross-sectional survey cannot show cause.