Context: Prior studies have demonstrated low rates of advance care planning (ACP)-particularly among non-white populations.
Objective: To examine attitudes and practices regarding ACP.
Design: Survey. Setting: 34 randomly selected New York City Senior Centers. Participants: 700 African American (n = 239), Latino (n = 237), or white (n = 234) older adults.
Intervention: Participants were administered a 51 item survey. Main Outcome Measures: Attitudes and beliefs about physicians’ trustworthiness, fatalism, beliefs about surrogate decision making, and comfort discussing end-of-life medical care; factors associated with ACP; and health care proxy completion rates.
Results: 35% of subjects had completed a health care proxy. There were no significant differences in completion rates across the three ethnic groups. Respondents who had a primary care physician (odds ratio 2.0, 95% CI 1.3 - 3.2), were more knowledgeable about advance directives (odds ratio 2.0, 95% CI 1.4 - 2.9), or had seen a friend or family member on a mechanical ventilator (odds ratio 1.5, 95% CI 1.02 - 2.1) were significantly more likely to have designated a health care proxy. Respondents who were only comfortable discussing advance care planning if the discussion was initiated by the physician (odds ratio 0.6, 95% CI 0.0 - 0.8) were significantly less likely to have completed a health care proxy.
Conclusions: African American, Hispanic, and white older adults had similarly high rates of advance directive completion. Predictors of advance directive completion were modifiable factors such as established primary care physicians, personal experience with mechanical ventilation, knowledge about advance care planning, and physicians willingness to effectively initiate such discussions. Some racial/ethnic differences in desire for collective family-based decision making that were observed have implications for the evolution of advance care planning policy that respects and operationalizes these preferences.