Uncertainty about advance care planning treatment preferences among diverse older adults.
The complexities associated with advance treatment decisions may result in decisional uncertainty and poorly informed choices, particularly among vulnerable populations such as minorities and patients with limited health literacy. Using a hypothetical scenario, we assessed uncertainty about treatment preferences among 205 chronically ill, English/Spanish-speaking older adults from a county outpatient clinic in San Francisco. Participants were read a scenrio that described a very poor health state and poor outcome of life support treatment. Participants were asked to imagine that they were in this scenario and to choose either: all life support treatments; try life support with an option of stopping; or no life support. They were then asked how certain they were about this decision. Forty-five percent of participants were uncertain about their decision. In adjusted multivariate analysis, Latinos and Asian/Pacific Islanders were more likely than Whites to be uncertain about their treatment decisions, as were participants with limited versus adequate literacy and poor versus good self-rated health. Many patients may be uncertain about advance treatment preferences. Culturally sensitive, literacy-appropriate tools are needed to address decisional uncertainty and to help patients prepare for decision making about their future health care.
Sudore
Rebecca L
RL
Veterans Affairs Medical Center, Department of Medicine, University of California, San Francisco, San Francisco, California 94121, USA. rebecca.sudore@ucsf.edu
Schillinger
Dean
D
Knight
Sara J
SJ
Fried
Terri R
TR
D032722:Advance Care Planning; D044466:Asian People / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000628:therapy*; D003657:Decision Making; D057220:Health Literacy; D006304:Health Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D057240:Patient Preference / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D012649:Self Concept; D035501:Uncertainty; D044465:White People / Q000706:statistics & numerical data