Predictors of Advance Care Planning in Older Women: The Nurses' Health Study. Issue 2 (10th December 2018)

• Record Type: Journal Article
• Authors: Kang, Jae H.; Bynum, Julie P.W.; Zhang, Lu; Grodstein, Francine; Stevenson, David G.
• Is Part Of: Journal of the American Geriatrics Society. Volume 67:Issue 2(2019)
• Page Start: 292
• Page End: 301
• Publication Date: 2018-12-10
• Subjects: advance care planning -- nurses -- community dwelling -- epidemiology; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.15656
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract : BACKGROUND/OBJECTIVES: Relatively little is known regarding predictors of advance care planning (ACP) in former nurses. We aimed to evaluate potential predictors of ACP documentation and discussion. DESIGN: Cross‐sectional study, 2012‐2014. SETTING: Nurses' Health Study. PARTICIPANTS: A total of 60, 917 community‐dwelling female nurses aged 66 to 93 years living across the United States. MEASUREMENTS: Based on self‐reports, participants were categorized as having (1) only ACP documentation, (2) ACP documentation and a recent ACP discussion with a healthcare provider, or (3) neither. Multivariable log‐binomial models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of the two separate ACP categories vs those with neither. We evaluated various demographic, health, and social factors. RESULTS: The large majority (84%) reported ACP documentation; 35% reported a recent ACP discussion. Demographic factors such as age and race were associated with both ACP categories. In multivariable analyses, race was most strongly associated: compared with whites, African Americans were 27% less likely (PR = 0.73; 95% CI = 0.69‐0.78) to report ACP documentation alone and 41% (PR = 0.59; 95% CI = 0.54‐0.66) less likely to report documentation with discussion. Additionally, health/healthcare‐related characteristics were more strongly associated with ACP documentation plus discussion. Women with functional limitations (PR = 1.15; 95% CI = 1.10‐1.20), women who were recently hospitalized (PR: 1.10; 95% CI = 1.08‐1.12) or women who had seen a physician for health symptoms (PR = 1.43; 95% CI = 1.35‐1.52) or screening (PR = 1.40; 95% CI = 1.32‐1.49) were more likely to report having both ACP documentation and discussion. Social factors showed limited relationships with ACP documentation only; for documentation plus discussion, being widowed and living alone was associated with higher prevalence (PR = 1.21; 95% CI = 1.19‐1.24) and having little emotional support was associated with lower prevalence (PR = 0.84; 95% CI = 0.81‐0.86). CONCLUSIONS: Among older nurses, most of whom reported having documented ACP, 35% reported recent patient‐clinician ACP discussions, indicating a major participatory gap in an element critical to ACP effectiveness. Even in nurses, African Americans reported less ACP documentation or discussion.J Am Geriatr Soc 67:292–301, 2019.