title: Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates.
abstract: BACKGROUND
  African Americans' beliefs about end-of-life care may differ from those of whites, but racial differences in advance care planning (ACP) outcomes are unknown.
  
  
  OBJECTIVE
  The aim of this study was to compare the efficacy of an ACP intervention on preparation for end-of-life decision making and post-bereavement outcomes for African Americans and whites on dialysis.
  
  
  METHODS
  A secondary analysis of data from a randomized trial comparing an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) with usual care was conducted. There were 420 participants, 210 patient-surrogate dyads (67.4% African Americans), recruited from 20 dialysis centers in North Carolina. The outcomes of preparation for end-of-life decision making included dyad congruence on goals of care, surrogate decision-making confidence, a composite of the two, and patient decisional conflict assessed at 2, 6, and 12 months post-intervention. Surrogate bereavement outcomes included anxiety, depression, and post-traumatic distress symptoms assessed at 2 weeks, and at 3 and 6 months after the patient's death.
  
  
  RESULTS
  SPIRIT was superior to usual care in improving dyad congruence (odds ration [OR] = 2.31, p = 0.018), surrogate decision-making confidence (β = 0.18, p = 0.021), and the composite (OR = 2.19, p = 0.028) 2 months post-intervention, but only for African Americans. SPIRIT reduced patient decisional conflict at 6 months for whites and at 12 months for African Americans. Finally, SPIRIT was superior to usual care in reducing surrogates' bereavement depressive symptoms for African Americans but not for whites (β = -3.49, p = 0.003).
  
  
  CONCLUSIONS
  SPIRIT was effective in improving preparation for end-of-life decision-making and post-bereavement outcomes in African Americans.
authors: 1 Nell Hodgson School of Nursing, Emory University , Atlanta, Georgia .
authors: Mi-Kyung
authors: MK
authors: Song
authors: 2 School of Nursing, University of Wisconsin-Madison , Madison, Wisconsin.
authors: Sandra E
authors: SE
authors: Ward
authors: 3 School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors: Feng-Chang
authors: FC
authors: Lin
authors: 4 School of Nursing, Johns Hopkins University , Baltimore, Maryland.
authors: Jill B
authors: JB
authors: Hamilton
authors: 5 School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors: Laura C
authors: LC
authors: Hanson
authors: 6 UNC Kidney Center , Chapel Hill, North Carolina.
authors: Gerald A
authors: GA
authors: Hladik
authors: 3 School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors: Jason P
authors: JP
authors: Fine
mesh_terms: D032722:Advance Care Planning; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001601:Bereavement; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D044465:White People