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Text
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URL Address
<a href="http://doi.org/10.1093/geront/gnx129" target="_blank" rel="noreferrer noopener">http://doi.org/10.1093/geront/gnx129</a>
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Pages
338-338
Issue
2
Volume
59
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Title
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Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments
Publisher
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The Gerontologist
Date
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2019
2019-04
Subject
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Advance directives; African Americans; CONFIDENCE intervals; Gerontology And Geriatrics; Judgments; Nurses; Nursing; Quality of care; Quality of life; Race; Racism; Research design; Residential segregation; Rural areas; Rural education; Rural urban differences; Segregation; Social science research; Social workers; Urban education
Creator
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Baughman Kristin R; Ludwick PhD R N-B C C N S F A A N Ruth; Jarjoura PhD David; Kropp BS Denise; Shenoy BS Vimal
Description
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Background and Objectives Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions Research Design and Methods Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. Results Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78) Discussion and Implications Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.
Identifier
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<a href="http://doi.org/10.1093/geront/gnx129" target="_blank" rel="noreferrer noopener">10.1093/geront/gnx129</a>
2019
Advance Directives
African Americans
Baughman Kristin R
Confidence Intervals
Department of Family & Community Medicine
Gerontology And Geriatrics
Jarjoura PhD David
Judgments
Kropp BS Denise
Ludwick PhD R N-B C C N S F A A N Ruth
NEOMED College of Medicine
nurses
Nursing
Quality of care
Quality of Life
Race
RACISM
Research Design
Residential segregation
Rural Areas
Rural education
Rural urban differences
Segregation
September 2019 Update
Shenoy BS Vimal
Social science research
social workers
The Gerontologist
Urban education