Taking Advance Care Planning (ACP) to Diverse Older Adult Communities: Facilitators, Barriers, and Development of a Novel ACP Toolkit
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PROJECT SUMMARY/ABSTRACT Advance care planning (ACP) is a process by which adults share their values, goals, and preferences for medical care. It is associated with myriad positive outcomes, including higher patient and family satisfaction with end-of-life care and a higher likelihood of patients receiving care consistent with their goals, and is critical for older adults' self-determination and autonomy in medical decision-making. Yet, ACP is as low as 20-30% among older vulnerable populations including people of color and those with lower socioeconomic status, limited health literacy, and limited English proficiency. Barriers to ACP include patient and health system factors (e.g., knowledge, attitudes, AD complexity), but little is known about community-level factors (e.g., social networks, physical environments like senior centers). There is an increasing understanding that ACP is a socially mediated health behavior; therefore, it is likely that community-level factors play a large role, as has been shown in other behaviors like smoking cessation or exercise. The current lack of understanding of the community context as it relates to ACP hinders the design of effective, scalable, and sustainable interventions that can meaningfully increase ACP and also threatens to exacerbate disparities in ACP. This is particularly concerning given communities experiencing systemic disadvantage and racism also face tremendous health disparities, including in ACP. Thus, understanding the community context as it relates to ACP and overcoming community-level barriers to ACP is imperative. In San Francisco (SF), the Bayview-Hunters Point is a low socioeconomic neighborhood with high proportions of residents identifying as Black (30%) and Latinx (23%) and with low rates of ACP among older adult residents. The objective of this proposal is to explore community- level facilitators and barriers to ACP, and to refine and pilot test an ACP Community Toolkit in the Bayview. In partnership with the SF Department of Disability and Aging Services and the SF Palliative Care Workgroup, this proposal investigates two specific aims: 1) to explore ACP facilitators and barriers among community- based stakeholders (older adults, caregivers, religious leaders, case managers, administrative leaders of local organizations serving older adults) and culturally adapt and refine an ACP Community Toolkit to be used by and for community members, and 2) to conduct feasibility, acceptability, and pilot testing of the refined ACP Community Toolkit among community-dwelling older adults. This work will have a significant impact in increasing the reach and reducing disparities of ACP among vulnerable older adults. This work will lay the groundwork of a community-level, public-health approach to ACP that can eventually be applied to other communities and geographic locations.
