title: Uncertainty about advance care planning treatment preferences among diverse older adults.
abstract: 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.
authors.affiliation: Veterans Affairs Medical Center, Department of Medicine, University of California, San Francisco, San Francisco, California 94121, USA. rebecca.sudore@ucsf.edu
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Sudore
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Knight
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
mesh_terms: 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