Essential Advance Care Planning Intervention Features in Low-Income Communities: A Qualitative Study

Older adults with low socioeconomic status (SES) participate in advance care planning (ACP) at lower rates than those with higher SES. Community feedback is an essential component of intervention design for communities with fewer social and health resources to ensure that the intervention is relevant and meaningful.

To understand the perspectives for potential interventions, we aimed to qualitatively explore participant priorities for ACP intervention development.

Using a qualitative descriptive design, we recruited and conducted individual and one-time, semi-structured interviews with older adults (aged 50+) with low income (< $20,000/year) (n = 20), Recruitment methods included flyers and in-person recruitment and purposive and snowball sampling methods. Following a thematic analysis plan, themes emerged from recursive transcript review by two independent coders and inductive categorization of the most robust codes.

Two themes captured participants' perspectives regarding ACP intervention development: 1) specialist advocacy and reliability and 2) person-centered communication. Older adults with low SES prioritize ACP communication that is driven by their goals and that is led by trustworthy specialists that advocate for their needs.

Our work highlights that intervention preferences were informed by the prior strain and struggle of waiting on other kinds of health and social services. We propose an adapted model for community research collaboration to promote equity in addition to practice and policy recommendations.