ArticleJournal of the American Geriatrics Society2021
English and Spanish-speaking vulnerable older adults report many barriers to advance care planning.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 16 citations in OpenAlex.
- Team-Based Versus Technology-Based Supportive Cancer Care: A Mixed Methods Study of Multi-Site Implementation.Journal of the National Comprehensive Cancer Network : JNCCN · 2025Trial
- Facilitated Versus Patient-Directed Advance Care Planning Among Patients With Advanced Cancer: A Randomized Clinical Trial.JCO oncology practice · 2025Trial
- Complex advance care planning intervention in general practice (ACP-GP): a cluster-randomised controlled trial.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Trial
- A Qualitative Study to Characterize the Experiences of Patients and Caregivers With Dementia Diagnostic Disclosure Communication and Care Planning.Journal of geriatric psychiatry and neurology · 2026Article
- Advance Directive Completion Among Community-Dwelling Adults with Decompensated Cirrhosis.Digestive diseases and sciences · 2026Article
- "What are you afraid of?" A mixed methods exploration of serious illness communication with oncology patients on general internal medicine wards in Canada.BMC health services research · 2025Article
- Advance care planning and hospice utilization among Japanese Americans: a scoping review.Proceedings (Baylor University. Medical Center) · 2025Article
- Achieving goal-concordant care: Formal and informal advance care planning for White, Black, and Hispanic older adults.Journal of the American Geriatrics Society · 2024Article
- Quality and Satisfaction With Advance Care Planning Conversations Among English- and Spanish-Speaking Older Adults.Journal of palliative medicine · 2023Article
- Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND/
objectivesAdvance care planning (ACP) rates are low in diverse, vulnerable older adults, yet little is known about the unique barriers they face and how these barriers impact ACP documentation rates.
designValidated questionnaires listing patient, family/friend, and clinician/system-level ACP barriers and an open-ended question on ACP barriers.
settingTwo San Francisco public/Department of Veterans Affairs hospitals.
participantsOne thousand two hundred and forty-one English and Spanish-speaking patients, aged 55 and older, with two or more chronic conditions. MEASUREMENTS: The open-ended question on ACP barriers was analyzed using content analysis. We conducted chart review for prior ACP documentation. We used chi-square/Wilcoxon rank-sum tests and logistic regression to assess associations between ACP barriers and demographic characteristics/ACP documentation.
resultsParticipant mean age was 65 ± 7.4 years; they were 74% from racial/ethnic minority groups, 36% Spanish-speaking, and 36% with limited health literacy. A total of 26 barriers were identified (15 patient, 4 family/friend, 7 clinician/system-level), and 91% reported at least one ACP barrier (mean: 5.6 ± 4.0). The most common barriers were: (patient-level) discomfort thinking about ACP (60%), wanting to leave health decisions to "God" (44%); (family/friend-level) not wanting to burden friends/family (33%), assuming friends/family already knew their preferences (31%); (clinician/system-level) assuming doctors already knew their preferences (41%), and mistrust (37%). Compared with those with no barriers, participants with at least one reported barrier were more likely to be from a racial/ethnic minority group (76% vs 53%), Spanish-speaking (39% vs 6%), with fair-to-poor health (48% vs 34%), and limited health literacy (39% vs 9%) (p < 0.001 for all). Participants who reported barriers were less likely to have ACP documentation (adjusted odds ratio = 0.64, 95% confidence interval [0.42, 0.98]).
conclusionEnglish- and Spanish-speaking older adults reported 26 unique barriers to ACP, with higher barriers among vulnerable populations, and barriers were associated with lower ACP documentation. Barriers must be considered when developing customized ACP interventions for diverse older adults.
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