“Don’t Talk to Them About Goals of Care”: Understanding Disparities in Advance Care Planning

Structurally marginalized groups experience disproportionately low rates of advanced care planning (ACP). To improve equitable patient-centered end-of-life care, the researchers examined barriers and facilitators to ACP among clinicians as they are central participants in these discussions.

Conclusions: Most clinicians avoided ACP with certain racial and ethnic groups, those with limited English fluency, and persons with certain religious beliefs. Our findings provide evidence to support the development of clinician-level and institutional-level interventions and to reduce disparities in ACP.

Why This is Important: Making end-of-life decisions presents difficult choices for any family but too often there is less communication with Black families. They were less likely to receive the EOL care they wanted and more likely to receive noncurative but intensive end-of-life treatment. Advance directives are also less common among patients of color, and they have less favorable beliefs about hospice care. If nobody talks with Black families about end-of-life planning it can all go bad in a hurry.

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