Advanced Care Planning in Refugee Patients

Background: Advance care planning (ACP) for end-of-life care is an important part of medical care, but fewer than half of older adults in the US have completed ACP documents. Among some population groups, notably African Americans and American Indian/Alaska Natives, rates are even lower. However, there are no published data on the rate of ACP among refugees resettled in the US. Methods: We interviewed 28 refugee patients from 12 different countries of origin who were receiving care in a primary care clinic. They ranged in age from 30-77 years, with equal numbers of females and males. We asked them (a) if they knew what ACP documents were and if they did, (b) if they had prepared ACP documents, which we defined as living wills, medical durable power of attorney, or written advanced directive documents. Results: Only 6 (21.4%) of the 28 patients had heard of ACP and only 1 (3.6%) had prepared ACP documents. If they did not know about or have ACP documents, after explaining what they are we asked if they would be interested in discussing ACP with their physician; 22 (78.5%) of the 28 said they would have some interest in doing so. Discussion: Our results suggest that the percentage of refugees who have ACPs in place is very low. With the large number of refugees that have entered the US each year, more and more clinicians will be seeing refugees in their practice. They should consider including discussions about ACP in their care of these patients.