title: A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South.
abstract: BACKGROUND
  Despite growing efforts to facilitate advance care planning (ACP) to decrease health disparities in palliative care, low completion rates of advance directives (AD) have been consistently found among African Americans.
  
  
  OBJECTIVE
  The objective was to examine the feasibility of a multicomponent ACP intervention program that integrates motivational interviewing, evidence-based ACP facilitation program (Respecting Choices(®)), and health-literacy adjusted AD. This pilot study aims to address the unique barriers to ACP engagement among African Americans in the Deep South.
  
  
  METHODS
  The design was a mixed-method randomized controlled trial design. Analysis of covariance (ANCOVA) and thematic content analysis (TCA) were conducted to identify barriers and facilitators for ACP engagement and to assess feasibility, knowledge, and intention to complete an AD. Thirty community-dwelling African Americans (mean age M = 55.43, SD = 6.71, range = 47-73) were recruited from the Deep South and randomly assigned to receive intervention (n = 15) or educational material (n = 15) at a local university medical center.
  
  
  RESULTS
  All participants (n = 30) reported high satisfaction (M = 4.81, SD = 0.44, max score = 5) and increased intent to complete an AD at postintervention. A significant increase in knowledge on AD from baseline to postintervention was observed in the intervention group-t(14) = -3.06, p = 0.01, d = 1.67); no significant change was found for control. Lack of information, mistrust of doctors, and avoidance of discussing death were primary barriers to ACP discussions. Facilitators include ACP education, decreased mistrust, and proactive initiation of ongoing ACP discussions.
  
  
  CONCLUSIONS
  Feasibility data revealed successful implementation of a brief intervention to increase ACP engagement and willingness to complete an AD among southern African Americans.
authors: 1 Center for Palliative and Supportive Care, Department of Medicine, University of Alabama , Birmingham, Alabama.|2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama.
authors: Chao-Hui Sylvia
authors: CH
authors: Huang
authors: 2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama.|3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.
authors: Martha
authors: M
authors: Crowther
authors: 2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama.|3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.
authors: Rebecca S
authors: RS
authors: Allen
authors: 4 Center for the Advanced Study of Teaching and Learning, University of Virginia , Charlottesville, Virginia.
authors: Jamie
authors: J
authors: DeCoster
authors: 2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama.|3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.
authors: Giyeon
authors: G
authors: Kim
authors: 1 Center for Palliative and Supportive Care, Department of Medicine, University of Alabama , Birmingham, Alabama.|2 Alabama Institute on Aging, University of Alabama , Tuscaloosa, Alabama.|3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.|6 Birmingham VA Medical Center , Birmingham, Alabama.
authors: Casey
authors: C
authors: Azuero
authors: 3 Department of Psychology, University of Alabama , Tuscaloosa, Alabama.|5 Department of Psychiatry and Behavioral Sciences, East Virginia Medical School , Nortolk, Virginia.
authors: Xinying
authors: X
authors: Ang
authors: 1 Center for Palliative and Supportive Care, Department of Medicine, University of Alabama , Birmingham, Alabama.|6 Birmingham VA Medical Center , Birmingham, Alabama.
authors: Elizabeth
authors: E
authors: Kvale
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D001741:Black or African American; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015144:Southeastern United States