Abstract
BACKGROUND/OBJECTIVES: This study aims to identify resident characteristics associated with being offered and subsequently shown an advance care planning (ACP) video in the Pragmatic Trial of Video Education in Nursing Homes (PROVEN) and if differences are driven by within- and/or between-facility differences. DESIGN: Cross-sectional study, from March 1, 2016, to May 31, 2018. SETTING: A total of 119 PROVEN intervention nursing homes (NHs). PARTICIPANTS: A total of 43 303 new NH admissions. MEASUREMENTS: Data came from the Minimum Data Set and an electronic record documenting whether a video was offered and shown to residents. We conduct both naïve logistic regression models and hierarchical logistic models, controlling for NH fixed effects, to examine the overall differences in offer and show rate by resident characteristics. RESULTS: In naïve regression models, compared to white residents, black residents are 7.8 percentage point (pp) (95% confidence interval [CI] = −9.1 to −6.5 pp) less likely to be offered the video. These differences decrease to 1.3 pp (95% CI = −2.61 to −0.02 pp) when accounting for NH fixed effects. In fully adjusted models, black residents compared to white residents were 2.1 pp more likely to watch the video contingent on being offered (95% CI = 0.4-3.7 pp). Residents with cognitive impairment were less likely to be offered and shown the video. CONCLUSIONS: After controlling for NH fixed effects, there were smaller racial differences in being offered the video, but once offered, black residents were more likely to watch the video. This suggests that black residents are receptive to this type of ACP intervention but need to be given an opportunity to be exposed. J Am Geriatr Soc 68:603–608, 2020.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 603-608 |
| Number of pages | 6 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 68 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2020 |
| Externally published | Yes |
Bibliographical note
Funding Information:This work is supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director and cooperative agreement UH3AG49619 from the National Institute on Aging (NIA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr Palmer was supported by grant T32AG023480, and Dr Mitchell is supported by grant K24AG033640, both from the NIA.
Funding Information:
This work is supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director and cooperative agreement UH3AG49619 from the National Institute on Aging (NIA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr Palmer was supported by grant T32AG023480, and Dr Mitchell is supported by grant K24AG033640, both from the NIA. Dr Mor is the chair of the Independent Quality Committee at HCR ManorCare, a paid consultant to NaviHealth, Inc, and chairs its Scientific Advisory Board, and the former director at PointRight, Inc. Lacey Loomer is a paid consultant to the American Health Care Association. Dr Volandes is president of the Nous Foundation Inc (http://www.ACPDecisions.org), a not-for profit (501[c]3) foundation that disseminates educational videos. Dr Volandes has a financial interest in the not for profit, which was reviewed and is managed by Massachusetts General Hospital and Partners Healthcare in accordance with their conflict of interest policies. Study concept and design: Lacey Loomer, Angelo E. Volandes, Susan L. Mitchell, and Vincent Mor. Acquisition of data: Vincent Mor. Analysis and interpretation of data: Lacey Loomer, Angelo E. Volandes, Susan L. Mitchell, Emmanuelle Belanger, Ellen McCreedy, Jennifer A. Palmer, and Vincent Mor. Drafting of the manuscript: Lacey Loomer. Critical revision of the manuscript for important intellectual content: Lacey Loomer, Angelo E. Volandes, Susan L. Mitchell, Emmanuelle Belanger, Ellen McCreedy, Jennifer A. Palmer, and Vincent Mor. Funding sources did not have any role in the design, methods, subject recruitment, data collections, analysis, and preparation of the article.
Publisher Copyright:
© 2019 The American Geriatrics Society
Keywords
- advance care planning
- end-of-life care
- health disparities
- long-term care
