Wellness in Sickness and Health (The W.I.S.H. Project): Advance Care Planning Preferences and Experiences Among Elderly Latino Patients

ABSTRACT

Objective: To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos.

Methods: Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey.

Results: Patients were primarily Spanish speaking with an average of 2.7 chronic medical conditions. Most had not previously documented (95%) or discussed (76%) EOL wishes. Most were unaware they had control over their EOL treatment (61%), but valued learning about EOL options (83%). Post-counseling, 85% reported comfort discussing EOL goals compared to 66% pre-session, and 88% elected to complete an AD. Nearly half of patients reported a desire to discuss EOL wishes sooner.

Conclusions: Elderly Latino patients are interested in ACP, given individualized, culturally competent counseling in their preferred language.

Clinical Implications: Patients should be offered the opportunity to discuss and document EOL wishes at all primary care appointments, regardless of health status. Counseling should be completed in the patient’s preferred language, using culturally competent materials, and with family members present if this is the patient’s preference. Cultural-competency training for providers could enhance the impact of EOL discussions and improve ACP completion rates for Latino patients.

KEYWORDS:

• Advance health care directive
• Hispanic/Latino
• elderly
• palliative care
• medicine

Acknowledgments

The authors would like to express their gratitude to the study participants, the clinical staff at LAC+USC Geriatrics Primary Care Clinic, LAC+USC Medical Center’s Palliative Care Team, mentors Dr. John Su, Dr. Jimmy Hara, Rebecca Bravo and the Albert Schweitzer Fellowship (Los Angeles Chapter), and the following Keck School of Medicine of USC student volunteers - Serena Liu, Sarah Soliman, Molly Wilkerson, Alexa Chavez, and Taylor Whitaker – for their invaluable contributions to the W.I.S.H. Project. We would also like to thank Aging with Dignity for the Five Wishes advance directive used in this study. The ideas and opinions expressed herein are those of the authors alone, and endorsement by the authors’ institutions is not intended and should not be inferred.

Disclosure statement

Each author signed a form for disclosure of potential conflicts of interest. No authors reported any conflicts of interest in relation to this work.

Additional information

Funding

This project was not supported by internal or external funding sources.

Notes on contributors

Lauren Y Maldonado

Lauren Y Maldonado: Led study design, protocol/IRB writing, and data collection during the first year of the study, in collaboration with EMJ. Drafted the abstract, introduction and discussion with RBG. Took responsibility for editing the manuscript in its entirety with RBG. Takes overall responsibility for the integrity of this paper. Shares first authorship with RBG.

Ruth B Goodson

Ruth B. Goodson: Assumed leadership during the second year of the study. Translated study materials, including questionnaires and consent forms, into Spanish. Drafted the abstract, introduction and discussion with LYM. Took responsibility for all edits of the paper with LYM. Shares first authorship with LYM.

Matthew C Mulroy

Matthew C. Mulroy: Led data analysis and drafted the results.

Emily M Johnson

Emily M. Johnson: Led study design and data collection during the first year of the study in collaboration with LYM. Assisted with data analysis and drafted the methods.

Jo M Reilly

Jo Marie Reilly: Served as a mentor to the study team and provided technical support and expertise throughout study implementation, analysis and manuscript writing.

Diana C Homeier

Diana C. Homeier: Provided technical support and expertise throughout study implementation, analysis and manuscript writing. Served as lead clinical contact, study mentor, and liaison between study team and clinical staff at the LAC+USC Geriatrics Clinic.