The Evaluation of Health Literacy, Spiritual Coping, and Advance Care Planning Following a Culturally Sensitive Intervention for African American Cancer Patients (FR421A)

Abstract

Objectives: •Present results of a pilot‐intervention designed to increase advance care planning (ACP) engagement within an African American cancer population.•Describe an investigation into health literacy and religious coping in the context of ACP, with the intention of assessing barriers that impact the completion of advance directives. Original Research Background: Prior investigations into disparities in advance care planning (ACP) among African Americans (AAs) suggest that there is a need to develop interventions to increase engagement in the ACP process. Research Objectives: To test an intervention designed to increase awareness of and intention to complete advance directives (AD) and medical power of attorney (MPOA) among a cohort of AA cancer patients. Methods: AA breast, lung, colon, and prostate cancer patients (Stage II, III, or IV) were randomized to an intervention versus a usual care control group. Intervention participants met with an AA lay health advisor (LHA) who facilitated viewing of a video that addressed barriers to completion of ACP and subsequent discussion. Change in stage of intent to complete AD/MPOA was measured by Transtheoretical Stages of Change Model. Linear regression was conducted to evaluate whether the intervention was associated with a change in stage of intent to complete ACP from baseline to 1‐month assessment. Cancer health literacy and religious coping were analyzed as potential moderators. Results: Fifty‐six patients were enrolled (28 intervention group, 28 control group). The majority of patients (71%) were found to have high cancer‐related health literacy and high religious coping (53%). The intervention was associated with a progression in stage of intent to complete ADs at one month (B = ‐0.83, t(47) = ‐2.79) p = 0.007) versus controls. Increased intent to appoint an MPOA at 1 month was not statistically significant. Health literacy and religious coping were not associated with change in intention. Conclusion: This culturally sensitive intervention was associated with progression in stage of intent to complete ADs at 1‐month follow‐up assessment. Health literacy and religious coping were not considered moderators. Implications for Research, Policy, or Practice: This work highlights the possible utility of a culturally sensitive intervention designed to improve engagement in ACP among African Americans. Future research should continue to address barriers in this area.