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Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates
- Publication Year :
- 2016
- Publisher :
- The University of North Carolina at Chapel Hill University Libraries, 2016.
-
Abstract
- African Americans' beliefs about end-of-life care may differ from those of whites, but racial differences in advance care planning (ACP) outcomes are unknown.The aim of this study was to compare the efficacy of an ACP intervention on preparation for end-of-life decision making and post-bereavement outcomes for African Americans and whites on dialysis.A secondary analysis of data from a randomized trial comparing an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) with usual care was conducted. There were 420 participants, 210 patient-surrogate dyads (67.4% African Americans), recruited from 20 dialysis centers in North Carolina. The outcomes of preparation for end-of-life decision making included dyad congruence on goals of care, surrogate decision-making confidence, a composite of the two, and patient decisional conflict assessed at 2, 6, and 12 months post-intervention. Surrogate bereavement outcomes included anxiety, depression, and post-traumatic distress symptoms assessed at 2 weeks, and at 3 and 6 months after the patient's death.SPIRIT was superior to usual care in improving dyad congruence (odds ration [OR] = 2.31, p = 0.018), surrogate decision-making confidence (β = 0.18, p = 0.021), and the composite (OR = 2.19, p = 0.028) 2 months post-intervention, but only for African Americans. SPIRIT reduced patient decisional conflict at 6 months for whites and at 12 months for African Americans. Finally, SPIRIT was superior to usual care in reducing surrogates' bereavement depressive symptoms for African Americans but not for whites (β = -3.49, p = 0.003).SPIRIT was effective in improving preparation for end-of-life decision-making and post-bereavement outcomes in African Americans.
- Subjects :
- Male
Advance care planning
medicine.medical_specialty
Decision Making
030232 urology & nephrology
Decisional conflict
Dialysis patients
White People
law.invention
Advance Care Planning
03 medical and health sciences
0302 clinical medicine
Nursing
Randomized controlled trial
Renal Dialysis
law
Secondary analysis
Outcome Assessment, Health Care
North Carolina
Humans
Medicine
Family
030212 general & internal medicine
General Nursing
Aged
Randomized Controlled Trials as Topic
Aged, 80 and over
business.industry
Original Articles
General Medicine
Middle Aged
humanities
Black or African American
Anesthesiology and Pain Medicine
Family medicine
Anxiety
Female
Racial differences
medicine.symptom
business
Bereavement
Dyad
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....b1df8f9c05c213d9c06e009421fa9869
- Full Text :
- https://doi.org/10.17615/em7k-g921