Race-Stratified Randomized Trial Examining Advance Care Planning Engagement Among Older Adults

Advance care planning (ACP), including creation of advance care directives (ACDs), is underutilized by Black American older adults. This study aimed to evaluate the effects of a culturally sensitive ACD (Five Wishes), versus a standard state directive, on ACP engagement and value congruence scores among Black and White Americans. A race-stratified sample of 189 participants was randomized into ACD conditions. Race and condition were not independent predictors of ACP and value congruence engagement. Physician trust predicted ACP engagement and value congruence differentially. Results indicate that the use of state directives negatively impacts trust among Black Americans, which negatively impacts ACP engagement. Primary limitations include metrics of ACP/ACD completion, sample size, and demographic distribution. Findings add to the growing body of literature implying that values-driven, person-centered directives may increase engagement and reduce the disparity in ACP between Black and White Americans, promoting better quality, equitable care at the end of life.