Advance care planning (ACP) is crucial for ensuring that individuals’ end-of-life wishes are respected. However, significant disparities exist in ACP engagement, particularly among Latino populations. This study examines the feasibility and acceptability of the ACP-I Plan, a culturally tailored intervention designed to improve ACP communication and advance directive (AD) completion among older Latinos in Southern New Mexico.
Study Design and Participants:
A prospective, pretest/post-test, two-group, randomized, community-based pilot trial using mixed methods was conducted. Participants were Latino/Hispanic adults aged 50 or older with one or more chronic diseases, recruited from diverse community settings in Southern New Mexico.
Intervention:
All participants received basic ACP education. The intervention group (TX) received additional support:
- Emotional support addressing psychological distress.
- Systems navigation for resource access.
- Interactive ACP treatment decisional support incorporating motivational interviewing (MI) techniques.
Feasibility Measures:
Feasibility was assessed through recruitment strategies, enrollment rates, retention rates, MI counseling duration, visit type (home vs. telephone), and participant satisfaction. Benchmarks were pre-defined to evaluate success.
Results:
- Recruitment: Researchers contacted 104 patients, enrolling 74 (exceeding the benchmark of 50). A variety of community outreach methods were employed, including flyers, emails, stakeholder meetings, and educational sessions in community centers, churches, and assisted living facilities.
- Demographics: Participants (N=68 post attrition) were predominantly female (76.5%), with 48% born in the US and 51.4% in Mexico. Spanish language preference was prevalent (52.9%), and 31.4% had less than a sixth-grade education. Most participants had multiple chronic conditions (2 or more).
- Retention: Completion rates were high (91.4% for usual care, 92.3% for the intervention group), exceeding the 80% benchmark. Six participants withdrew before post-test due to illness or inability to be located.
- Intervention Delivery: The median time from screening to pretest was 3 days, and MI counseling sessions averaged 33 minutes. 78% of visits were conducted face-to-face.
Satisfaction:
Qualitative data revealed high satisfaction with the ACP-I Plan. Participants reported increased ACP knowledge, improved communication with family and healthcare providers, and a greater sense of preparedness.
Participants suggested improvements, including:
- More educational sessions in community settings.
- Repeated information delivery with concrete examples.
- Encouragement to ask questions and address fears.
- Incorporation of faith and spirituality into discussions.
Discussion:
The ACP-I Plan demonstrated feasibility and high acceptability among older Latinos in Southern New Mexico. This culturally tailored intervention successfully engaged a population often underrepresented in ACP research and healthcare services. The findings underscore the importance of culturally sensitive approaches to address disparities in ACP engagement. Early ACP discussions can empower individuals, reduce family conflict, and ensure that end-of-life care aligns with personal values and preferences.
Conclusion:
The ACP-I Plan offers a promising model for promoting ACP among older Latinos. Future research should explore scalability and long-term impacts on ACP outcomes. The study’s success highlights the potential of community-based interventions to improve end-of-life care for underserved populations. This pilot study lays the foundation for developing and implementing effective Advance Care Planning Tools For Latinos.
