Barriers and Solutions to Advance Care Planning among Homeless-Experienced Older Adults

被引:19
作者
Kaplan, Lauren M. [1 ,2 ]
Sudore, Rebecca L. [3 ]
Cuervo, Isabel Arellano [4 ]
Bainto, Dustin [5 ,6 ]
Olsen, Pamela [1 ,2 ]
Kushel, Margot [1 ,2 ]
机构
[1] Univ Calif San Francisco, Zuckerberg San Francisco Gen Hosp & Trauma Ctr, Ctr Vulnerable Populat, UCSF Box 1364, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Zuckerberg San Francisco Gen Hosp, Dept Med, Div Gen Internal Med, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Dept Med, Div Geriatr, San Francisco, CA 94143 USA
[4] Cornell Univ, Weill Cornell Med Coll, Ithaca, NY USA
[5] Univ Calif Berkeley, San Francisco Joint Med Program, UC Berkeley Sch Publ Hlth, Berkeley, CA 94720 USA
[6] Univ Calif San Francisco, Sch Med, San Francisco, CA 94143 USA
基金
美国国家卫生研究院;
关键词
advance care planning; homelessness; older adults; OF-LIFE CARE; DECISION-MAKING; END; INTERVENTION;
D O I
10.1089/jpm.2019.0550
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background/Objectives: Older homeless-experienced adults have low rates of advance care planning (ACP) engagement despite high rates of morbidity and mortality. To inform intervention development, we examined potential barriers and solutions to ACP engagement. Design: Cross-sectional qualitative study. Setting: We recruited adults who were homeless in the prior three years and >= 50 years of age in the San Francisco Bay Area, and recruited clinical stakeholders from a national meeting of homeless providers. We analyzed qualitative data using thematic analysis. Measurements: We conducted semistructured interviews with homeless-experienced older adults (n = 20) and focus groups with clinical stakeholders (n = 24) about perceived barriers and solutions to ACP engagement. Results: Participants considered ACP important, reflecting on deaths of people in their networks who had died. Participant-identified barriers to ACP included poor ACP knowledge, lack of familial ties and social isolation, competing priorities, avoidance and lack of readiness, fatalism and mistrust, and lack of ACP training for clinical and nonclinical staff. They identified solutions that included framing ACP as a way to provide meaning and assert choice, providing easy-to-read written documents focused on the populations' unique needs, tailoring content and delivery, initiating ACP in nonclinical settings, such as permanent supportive housing, and providing incentives. Conclusions: Both older homeless-experienced adults and clinical stakeholders believe that ACP is important, but acknowledge multiple barriers that impede engagement. By focusing on potential solutions, including capitalizing on opportunities outside of health care settings, focusing on the period after housing, and tailoring content, there are opportunities to improve ACP uptake.
引用
收藏
页码:1300 / 1306
页数:7
相关论文
共 25 条
[21]   Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel [J].
Sudore, Rebecca L. ;
Lum, Hillary D. ;
You, John J. ;
Hanson, Laura C. ;
Meier, Diane E. ;
Pantilat, Steven Z. ;
Matlock, Daniel D. ;
Rietjens, Judith A. C. ;
Korfage, Ida J. ;
Ritchie, Christine S. ;
Kutner, Jean S. ;
Teno, Joan M. ;
Thomas, Judy ;
McMahan, Ryan D. ;
Heyland, Daren K. .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2017, 53 (05) :821-+
[22]   A Novel Website to Prepare Diverse Older Adults for Decision Making and Advance Care Planning: A Pilot Study [J].
Sudore, Rebecca L. ;
Knight, Sara J. ;
McMahan, Ryan D. ;
Feuz, Mariko ;
Farrell, David ;
Miao, Yinghui ;
Barnes, Deborah E. .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2014, 47 (04) :674-686
[23]   Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study [J].
Tong, M. ;
Tieu, L. ;
Lee, C. T. ;
Ponath, C. ;
Guzman, D. ;
Kushel, M. .
JOURNAL OF PUBLIC HEALTH, 2019, 41 (02) :240-249
[24]  
Tong MS, 2019, J INTERPERS VIOLENCE, V28, p886260519850532
[25]   End-of-life care in black and white: Race matters for medical care of dying patients and their families [J].
Welch, LC ;
Teno, JM ;
Mor, V .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2005, 53 (07) :1145-1153