Thinking ahead project: a pilot intervention study to increase acceptability of advance care planning among African American middle-aged and older adults

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University of Alabama Libraries

This pilot study investigates the feasibility and provides a limited efficacy testing of an innovative intervention, the Thinking Ahead Project (TAP), designed to increase acceptability of advance care planning (ACP) among African Americans. A mixed-method randomized control trial (RCT) was conducted to examine the feasibility and efficacy of the TAP intervention. 30 African Americans aged 45 and above were recruited and randomized to either the intervention group (n=15), or the control group (n=15). Feasibility was assessed with a program satisfaction survey. ANCOVAs and/or regression analyses were conducted to assess the effect of the intervention on the primary outcomes, including acceptability, knowledge, preference, and intention to complete an advance directive (AD). Semi-structured interview data were analyzed using thematic content analysis to identify barriers to engage in ACP discussions, strategies to overcome barriers, stages of health behavior change, and experiences during the TAP intervention. Feasibility data demonstrated successful implementation and acceptability of the multi-component TAP intervention. All participants reported increased intention to complete an AD at post-intervention regardless of the group assignment. A significant increase in knowledge from baseline to post-intervention was found in the intervention group, t (14) = -3.055, p = .009, eta squared =.41. The intervention participants also reported a preference for the health literacy adapted advance directive form over the standard form, especially among those with low health literacy. "Lack of information on ACP" was identified as one of the primary barriers for individuals to engage in ACP discussions. Overall, the TAP intervention demonstrates promise as a brief intervention to increase acceptability of ACP among African Americans. Findings can be applied to develop culturally sensitive intervention programs that improve acceptability and engagement in ACP among racial/ethnic minorities.

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Clinical psychology, Health education, African American studies