Background: Prior research has shown that advance care planning (ACP) knowledge and discussion varies among racial and ethnic groups. However, little is known if similar disparities exist within the sexual minority (SM) population. Objectives: To investigate racial disparities in ACP knowledge, discussion, and decision making within the SM population. Methods: Data from an online survey (N = 281) asked Black and White SM adults ages 50+ about their knowledge and actions about future healthcare wishes and their healthcare experiences. A series of multivariable logistic regressions were conducted to examine the association between ACP knowledge, discussion, and medical decision-making and race, while adjusting for other demographic and health-related variables. Results: On average, respondents were 57 years old (SD = 6.04) and just over half identified as being White (52%) and as men (55%). Most participants had heard of ACP (74%) and had an ACP discussion with someone (65%). Sixty-six percent of participants were very comfortable with medical decision-making. White SM adults had higher odds of having ACP knowledge (aOR = 3.56; 95% CI = 1.78, 7.07) and discussions (aOR = 2.43; 95% CI = 1.28, 4.61). While no racial differences were found in comfort with medical decision-making, other sociodemographics were significantly associated with comfort with medical decision-making. Conclusion: Outcomes from this work indicate persistent racial disparities in ACP within the SM population in addition to highlighting other factors that influence ACP. These findings emphasize the need for resources to address this systemic issues and to ensure that SM adults have access to and engage in ACP.
SudoreRLHeylandDKBarnesDE, et al.Measuring advance care planning: optimizing the advance care planning engagement survey. J Pain Symptom Manag. 2017;53(4):669-681.
2.
BischoffKESudoreRMiaoYBoscardinWJSmithAK. Advance care planning and the quality of end-of-life care in older adults. J Am Geriatr Soc. 2013;61(2):209-214.
3.
EnguidanosSAilshireJ. Timing of advance directive completion and relationship to care preferences. J Pain Symptom Manag. 2017;53(1):49-56.
4.
LovellAYatesP. Advance Care Planning in palliative care: a systematic literature review of the contextual factors influencing its uptake 2008-2012. Palliat Med. 2014;28(8):1026-1035.
5.
RaoJKAndersonLALinFCLauxJP. Completion of advance directives among U.S. consumers. Am J Prev Med. 2014;46(1):65-70.
6.
JohnsonKSKuchibhatlaMTulskyJA. What explains racial differences in the use of advance directives and attitudes toward hospice care?J Am Geriatr Soc. 2008;56(10):1953-1958.
7.
PortanovaJAilshireJPerezCRahmanAEnguidanosS. Ethnic differences in advance directive completion and care preferences: what has changed in a decade?J Am Geriatr Soc. 2017;65(6):1352-1357.
8.
KhoslaNCurlALWashingtonKT. Trends in engagement in advance care planning behaviors and the role of socioeconomic status. Am J Hosp Palliat Care. 2016;33(7):651-657.
9.
CarrD. The social stratification of older adults' preparations for end-of-life health care. J Health Soc Behav. 2012;53(3):297-312.
10.
SiconolfiDThomasEGChenEK, et al.Advance care planning among sexual minority men: sociodemographic, health care, and health status predictors. J Aging Health. 2023;3:1.
11.
MackJWWeeksJCWrightAABlockSDPrigersonHG. End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences. J Clin Oncol. 2010;28(7):1203-1208.
12.
SilveiraMJKimSYLangaKM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362(13):1211-1218.
13.
FogliaMBFredriksen-GoldsenKI. Health disparities among LGBT older adults and t he role of nonconscious bias. Hastings Cent Rep. 2014;44(4):S40-S44.
14.
CzajaSJSabbagSLeeCC, et al.Concerns about aging and caregiving among middle-aged and older lesbian and gay adults. Aging Ment Health. 2016;20(11):1107-1118.
15.
SeelmanKLLewinsonTEnglemanLAllenA. Motivations for advance care and end-of-life planning among lesbian, gay, and bisexual older adults. Qual Soc Work. 2019;18(6):1002-1016.
16.
LampeNMBarbeeHTranNMBastowSMcKayT. Health disparities among lesbian, gay, bisexual, transgender, and queer older adults: a structural competency approach. Int J Aging Hum Dev. 2023;3:1.
17.
Fredriksen-GoldsenKKimHEmletC, et al.The Aging and Health Report: Disparities and Resilience Among Lesbian, Gay, Bisexual, and Transgender Older Adults. Seattle: Institute for Multigenerational Health; 2011.
18.
HashKMMankowskiM. Caregiving in the LGBT community. Annu Rev Gerontol Geriatr. 2017;37:77-87.
19.
SteinGLBonuckKA. Attitudes on end-of-life care and advance care planning in the lesbian and gay community. J Palliat Med. 2001;4(2):173-190.
20.
de VriesBGutmanG. End-of-life preparations among LGBT older adults. Generations. 2016;40(2):46-48.
21.
MarsackJStephensonR. Exploring the utilization of end-of-life documentation among an online sample of sexual- and gender-minority individuals in the United States. J Gay Lesb Soc Serv. 2017;29(3):273-279.
22.
ReichAJPerezSFlemingJ, et al.Advance care planning experiences among sexual and gender minority people. JAMA Netw Open. 2022;5(7):e2222993.
23.
DaalemanTPEmmettCPDobbsDWilliamsSW. An exploratory study of advance care planning in seriously ill African-American elders. J Natl Med Assoc. 2008;100(12):1457-1462.
24.
SandersJJJohnsonKSCannadyK, et al.From Barriers to Assets: rethinking factors impacting advance care planning for African Americans. Palliat Support Care. 2019;17(3):306-313.
25.
HongMYiE-HJohnsonKJAdamekME. Facilitators and barriers for advance care planning among ethnic and racial minorities in the US: a systematic review of the current literature. J Immigr Minority Health. 2018;20:1277-1287.
26.
CarrD. Racial and ethnic differences in advance care planning: identifying subgroup patterns and obstacles. J Aging Health. 2012;24(6):923-947.
27.
AndersenRM. Revisiting the behavioral model and access to medical care: does it matter?J Health Soc Behav. 1995;36(1):1-10.
28.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
29.
HarrisPATaylorRMinorBL, et al.The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
30.
Health and Retirement Study. 2018, University of Michigan: Ann Arbor, MI.
KempCLSkipperADBenderAAPerkinsMM. Turning it over to god: African American assisted living residents' end-of-life preferences and advance care planning. J Gerontol B Psychol Sci Soc Sci. 2023;78(10):1747-1755.
33.
AyhanCHBBilginHUlumanOTSukutOYilmazSBuzluS. A systematic review of the discrimination against sexual and gender minority in health care settings. Int J Health Serv. 2020;50(1):44-61.
34.
HsiehNShusterSM. Health and health care of sexual and gender minorities. J Health Soc Behav. 2021;62(3):318-333.
35.
CerezoAChingSRamirezA. Healthcare access and health-related cultural norms in a community sample of Black and latinx sexual minority gender expansive women. J Homosex. 2023;70(5):782-805.
36.
SingletonMAdamsMAPoteatT. Older Black lesbians' needs and expectations in relation to long-term care facility use. Int J Environ Res Public Health. 2022;19(22):15336.
37.
SingletonMCEnguidanosSM. Exploration of demographic differences in past and anticipated future care experiences of older sexual minority adults. J Appl Gerontol. 2022;41(9):2045-2055.
38.
CroghanCFMooneRPOlsonAM. Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults. J Homosex. 2014;61(1):79-102.
39.
BoehmerUClarkMALordEMFredmanL. Caregiving status and health of heterosexual, sexual minority, and transgender adults: results from select U.S. Regions in the behavioral risk factor surveillance system 2015 and 2016. Gerontol. 2019;59(4):760-769.
40.
Metlife Mature Market Institute, The Lesbian and Gay Aging Issues. Out and Aging: The MetLife Study of Lesbian and Gay Baby Boomers. Journal of GLBT Family Studies. 2010;6(1):40-57.
41.
BoersmaPBlackLIWardBW. Prevalence of multiple chronic conditions among US adults, 2018. Prev Chronic Dis. 2020;17:E106.
42.
St SauverJLBoydCMGrossardtBR, et al.Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open. 2015;5(2):e006413.
43.
GreenDCWheelerEM. A qualitative exploration of facilitators for health service use among aging gay men living with HIV. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2019;18:2325958219880569.
44.
SingletonMCGreenDCEnguidanosSM. Identifying healthcare stereotype threat in older gay men living with HIV. J Appl Gerontol. 2023;42(9):1965-1973.
45.
BrownKEKimJStewartTFultonEMcCarreyAC. Positive, but not negative, self-perceptions of aging predict cognitive function among older adults. Int J Aging Hum Dev. 2021;93(1):543-561.
46.
KlusmannVSproesserGWolffJKRennerB. Positive self-perceptions of aging promote healthy eating behavior across the life span via social-cognitive processes. J Gerontol B Psychol Sci Soc Sci. 2019;74(5):735-744.
47.
LevyBRMyersLM. Preventive health behaviors influenced by self-perceptions of aging. Prev Med. 2004;39(3):625-629.
48.
OhlsonM. Effects of socioeconomic status and race on access to healthcare in the United States. Perspectives. 2020;12(1):2.
49.
AddoMServonL, Income volatility and healthcare decision-making. 2022.
50.
McMaughanDJOloruntobaOSmithML. Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Front Public Health. 2020;8:231.
51.
WilliamsNKoganR. Factors associated with evidence-based decision-making among patients and providers. J Comp Eff Res. 2019;8(9):709-719.
52.
WangY-HEnguidanosS. The relationship between multiple chronic conditions and physician visits in advance care planning activities. Am J Hosp Palliat Med. 2023;40(9):965-970.
53.
CliftJBKirbyJ. Health care access and perceptions of provider care among individuals in same-sex couples: findings from the Medical Expenditure Panel Survey (MEPS). J Homosex. 2012;59(6):839-850.
