Advance Care Planning

Transcription

1 Advance Care Planning Starting the Conversation in Minnesota s Latino Communities Leah Habicht and Liz McLean

2 DNP Evidence-Based Project Winona State University students in the Doctor of Nursing Practice program (DNP) The DNP is a doctoral program but differs from a PhD program Instead of conducting original research, DNP students implement a project based on evidence from research The goal of each DNP project is to improve clinical practice and patient outcomes Our DNP project focuses on improving advance care planning practices within the Latino community Wonderful opportunity to work with Honoring Choices Minnesota and Barbara Greene

3 Background Leah RN for 11 years Currently working at Fairview Southdale ICU Acute Care Nurse Practitioner DNP program at Winona State University Liz RN for 14 years Currently work at Fairview Home Care and Hospice Family Nurse Practitioner DNP program at Winona State University

4 Introduction to the Problem Approximately 30% of Whites living in the United States have an advance directive. Rao, Anderson, Lin, & Laux, 2014;Wenger, Shugarman & Wilkinson, 2008 Only 10-17% of Latinos living in the United States have an advance directive. Ko and Lee (2014) Rao, Anderson, Feng-Chang and Laux (2014)

5 Purpose of the Project Introduce the Spanish version of the Honoring Choices Voices of Advance Care Planning video in Latino communities within the Twin Cities metropolitan area Evaluate perceptions of the Spanish-language version of the Voices of Advance Care Planning video.

6 Benefits of this Project Enhance participant knowledge of advance care planning Provide an opportunity for participants to engage in conversations about end-of-life care Provide an opportunity for participants to complete a health care directive Participants may also benefit by contributing valuable information about the advance care planning process within the Latino community.

7 Question Does implementation of video education using culturally-sensitive and linguistically-appropriate explanations of advance care planning in a community setting influence whether Latino adults living in the Twin Cities metropolitan area intend to start conversations about end-of-life choices and/or complete a health care directive?

8 Barriers Universal barriers Healthy adults Health literacy Death avoidance Barriers specific to Latino culture Group decision-making (Familismo and personalismo) Truth-telling Respect for authority (Jeraquismo) Religion and fatalism Acculturation Attitudes

9 Universal Facilitators Clinician-initiated conversations Community initiatives Iterative interventions Interactive interventions Decision aids (Video education) Culturally-sensitive educational materials Longer relationship with health care provider Older age Knowledge Literacy

10 Plan for Implementation Introduction of the Voices of Advance Care Planning video at 4 Latino community meetings Provide FAQ brochure from Honoring Choices Participants will watch the video Participants will fill out the post-video survey Post-video discussion

11 Community Meeting #1 Centro Tyrone Guzman Minneapolis, Minnesota July 7 th, Latino elders

12 Preliminary Findings Demographic Data What language do you speak most often in your home? 83% Spanish 11% English 6% English/Spanish

13 Preliminary Findings Demographic Data How long have you lived in the United States? 11% Unanswered 6% All of my life 5% Less than 5 years 78% More than 5 years

14 Preliminary Findings Video Impression How useful was the information shared in the Honoring Choices Minnesota video to you on a scale of 1-10? 1=Not Useful 10= Very Useful Mean Score=9.3

15 Preliminary Findings Video Impression Who do you want to talk with about your end of life wishes? 6% My doctor or health care provider 11% My doctor or health care provider/my family 78% My family 5% My doctor or health care provider/my family/friends, community members or neighbors

16 Preliminary Findings Health Care Directive Before watching the video, did you know what a health care directive was? 61% Yes 39% No

17 Preliminary Findings Health Care Directive How important is it to you to write down your wishes for end of life care on a scale of 1 to 10? 1= Not Important 10= Very Important Mean Score =9.4

18 Next Steps August 5 th Meeting with a New Hope faith-based organization August 30 th - Meet with another group of elders at Centro Tyrone Guzman Tentative meeting with a Brooklyn Park faith-based organization Manuscript for publication Feel free to contact us for more information Leah Habicht: lhabicht13@winona.edu Liz McLean: emclean12@winona.edu

19 References Abel, J., Pring, A., Rich, A., Malik, T., & Verne, J. (2013). The impact of advance care planning on place of death, a hospice retrospective cohort study. Supportive and Palliative Care, 00, 1-6. doi: /bmjspcare Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, Del Rio, N. (2010). The influence of Latino ethnocultural factors on decision making at the end of life: Withholding and withdrawing artificial nutrition and hydration. Journal of Social Work in the End-of-Life and Palliative Care, 6(3/4), doi: / Ko, E. & Lee, J. (2014). Completion of advance directives among low-income older adults: Does race/ethnicity matter? American Journal of Hospice, 31(3), doi: /

20 References Mack, J. W., Weeks, J. C., Wright, A. A., Block, S. D., & Prigerson, H. G. (2010). End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt of care consistent with preferences. Journal of Clinical Oncology, 28(7), doi: /JCO Rao, J. K., Anderson, L. A., Lin, F.C., & Laux, J. P. (2014). Completion of advance directives among U.S. consumers. American Journal of Preventative Medicine, 46(1), doi: /j.amepre Riva, J., Malik, K., Burnie, S., Endicott, A., & Busse, J. (2012). What is a research questions? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3). Rogers, E. M. (1995). Diffusion of Innovations. New York, NY: The Free Press.

21 References Wendler, D. & Rid, A. (2011). Systematic review: The effect on surrogates of making treatment decisions for others. Annals of Internal Medicine, 154, Zhang, B., Wright, A. A., Huskamp, H. A., Nilsson, M. C., Maciejewski, M. C., Earle, C. C.Prigerson, H. G. (2009). Health care cost in the last week of life: Associations with end-of-life conversations. Archives of Internal Medicine, 169(5),