Background: Studies show that African Americans are less likely than other ethnic groups to
complete advance directives. However, what influences African Americans' decisions to complete
or not complete advance directives is unclear.
Methods: Using a faith-based promotion model, 102 African Americans aged 55 years or
older were recruited from local churches and community-based agencies to participate in a
pilot study to promote advance care planning. Focus groups were used to collect data on participants'
preferences for care, desire to make personal choices, values and attitudes, beliefs
about death and dying, and advance directives. A standardized interview was used in the focus
groups, and the data were organized and analyzed using NUDIST 4 software (QRS Software,
Victoria, Australia).
Results: Three fourths of the participants refused to complete advance directives. The following
factors influenced the participants' decisions about end-of-life care and completion
of an advance directive: spirituality; view of suffering, death, and dying; social support networks;
barriers to utilization; and mistrust of the health care system.
Conclusion: The dissemination of information apprises individuals of their right to self-determine
about their care, but educational efforts may not produce a significant change in behavior
toward completion of advance care planning. Thus, ongoing efforts are needed to improve
the trust that African Americans have in medical and health care providers.
