Understanding Underuse of Advance Care Planning Among a Cohort of African American Patients With Advanced Cancer: Formative Research That Examines Gaps in Intent to Discuss Options for Care.

The final analysed number is not stated; 23 agreed to participate and 1 was later deemed ineligible. The sample was small and came from one safety-net hospital, so the results may not apply to African American patients with advanced cancer in other settings. Caregiver data were not analyzed because few caregivers completed assessments. Only overall quality of life was assessed; the McGill total score and subscales could not be calculated, so the quality-of-life findings may be incomplete. Advance directive and medical power of attorney documentation may have been missed if care occurred outside the hospital system. Survival estimates may be optimistic because deaths outside the safety-net system could have been missed. The intent questions used readiness-to-change concepts that have been validated mainly in majority populations, and there are no validated tools for knowledge of advance care planning, palliative care, or hospice. No significant associations were found between intent and completed behaviors, and the small sample limited analysis of caregiver and religious factors.

The authors declared no potential conflicts of interest.

Do not read the positive quality-of-life ratings as evidence that these patients had low symptom burden or did not need palliative care discussions. Many still reported pain and breathlessness, and most had no intent to discuss hospice within six months.