Title
Advance Care Planning in the African American Church: Taking the Dis-ease Out of the Conversation
Credentials of Corresponding Author
DNP, APRN, FNP-BC
Name of Faculty Advisor
Dr. Jorgia Connor
Nature and scope of the project
Project objectives were to improve facilitation of advance care planning (ACP) conversations in the African American (AA) church via the development and implementation of an evidence-based program and to evaluate the effects of an evidence-based intervention on the attitudes (self-efficacy and readiness) of AA faith-leaders as related to ACP.
Synthesis and analysis of supporting literature
Two thirds of racial/ethnic minorities age 65+ have 2 or more chronic conditions; compared to Caucasian counterparts, AA are twice as likely to opt for aggressive care and less likely to choose a substitute decision maker, complete an advance directive, or participate in end-of-life conversations. Barriers between ACP and AA include faith in a higher power/God, belief that end-of-life issues should be managed via religious practices, and lack of knowledge and medical mistrust.
Project implementation
A purposive sampling of AA church leaders (n=14) participated in a church-based ACP intervention featuring the Conversation Ready toolkit and received $50 total in gift cards. Inclusion criteria: leaders, 18 years or older, able to read and write English. The 2-day project: 2 consecutive Saturdays, 5 hours each. Leaders self-reported via 15-item ACP Engagement Surveys (ACPES), collected across 3 time-points: beginning of session #1 (pre-test/baseline), 1 week after session #1 (post-test #1), and 1 week after session #2 (post-test#2).
Evaluation criteria
Paired t-tests were used to determine significant changes with level of significance=0.05. The ACPES Likert scales for self-efficacy (1-not at all to 5-extremely) and readiness (1-I have never thought about it to 5-I have already done it) were utilized.
Outcomes
Mean scores for self-efficacy increased across all 3 time-points from 3.69 to 4.26 to 4.54, respectively. Pre-test/baseline to post-test #2, statistically significant change was noted (t=2.993, df=12, p=0.011). Mean scores for readiness increased across all 3 time-points from 2.73 to 3.48 to 3.59, respectively. Pre-test/baseline to post-test #2, statistically significant change was again noted (t=3.695, df=13, p=0.003).
Recommendations
Further research may find this tool effective in other communities of faith, regardless of religious affiliations, racial/ethnic background, or church size. There is potential for sustainable ACP programming through collaboration between healthcare personnel and communities of faith.
Advance Care Planning in the African American Church: Taking the Dis-ease Out of the Conversation