Is Annual Income a Predictor of Completion of Advance Directives (ADs) in Patients With Cancer. (May 2019)

• Record Type: Journal Article
• Authors: Saeed, Fahad; Xing, Guibo; Tancredi, Daniel J.; Epstein, Ronald M.; Fiscella, Kevin A.; Norton, Sally A.; Duberstein, Paul R.
• Is Part Of: American journal of hospice & palliative care. Volume 36:Number 5(2019)
• Page Start: 402
• Page End: 407
• Publication Date: 2019-05
• Subjects: low income -- education -- advance directives -- socioeconomic disparities -- end-of-life care; Hospice care -- Periodicals; Palliative treatment -- Periodicals; 362.175
• DOI: 10.1177/1049909118813973
• Languages: English
• ISSNs: 1049-9091

Abstract

Context: Completion of advance directives (ADs) enhances the likelihood of receiving goal-concordant treatments near the end of life. Previous research on community samples have shown that completion of ADs is less common in lower socioeconomic status demographic group; there is a paucity of such research in patients with cancer. Objectives: To study the effect of income and education on the completion of ADs. Hypothesis: Patients with cancer having lower incomes and education levels would be less likely to report completing ADs. Methods: We conducted cross-sectional analyses of data provided by patients (n = 265) enrolled in the Values and Options in Cancer Care clinical trial. Patients with advanced cancer reported whether they had (1) completed a living will or (2) designated a health-care proxy. Response options for both questions were yes (scored 1), no (scored 0), and unsure (scored 0). We studied the association of lower household income (≤US$20 000) and education level (never attended college) with AD scores. Results: Patients with lower annual incomes had lower AD scores (estimate −0.44; confidence intervals [CI]: −0.71 to −0.16, P = .001); the association between higher educational attainment (some college or more) and completion of ADs was not statistically significant (estimate 0.04, CI: −0.16 to 0.24, P = .70). Conclusion: Interventions to promote completion of ADs among lower income patients with serious illnesses are needed.