Doctor talking with older patient

Goals-of-care conversations and advance directives don’t necessarily benefit certain racial groups more than others in terms of achieving individuals’ end-of-life goals, a new study showed. Having formal advanced care planning (ACP) in place was linked to higher odds of receiving care that aligned with individuals’ goals, the researchers found.

The study evaluated how ACP and goal-concordant care (GCC) — an approach that aims to meet the patient’s goal and includes ACP and conversations about care goals —  affected people of different races. The report was published on May 18 in the Journal of the American Geriatrics Society.

The framework is especially important for people in racial or ethnic minority populations who have a greater risk of poor end-of-life outcomes and don’t receive GCC. The researchers noted that minority groups use ACP less overall. 

Some older adults want comfort-focused care instead of life-sustaining treatment. Older adults are more likely to receive hospice care at the end of life compared to previous decades, but a lot of people still report care that didn’t meet their preferences, the authors noted.

Researchers used data from 2012 to 2018 that was part of the biennial Health and Retirement Study. Data came from 2,048 older adults. Of them, 83.1% of white people received GCC. That compares with 75.3% of Blacks and 71.3% of Hispanics. The team looked at the different types of ACPs used by racial groups. They defined formal care as having ACP and informal care as goals-of-care conversations. Of the participants, 15.1% had no ACP, 12.6% had a formal ACP but no goals conversations, 9.5% had only informal plans, and 62.8% both. 

Results showed that informal compared with no informal ACP was linked to higher odds of receiving GCC. Black people with formal ACP were more likely to receive GCC than those who did not have formal ACP. There weren’t any major differences in people among racial groups who had no ACP, informal ACP only or both types of ACP. 
Overall, talking about goals of care is associated with higher likelihood of goal-concordant end-of-life care in older adults. Clinicians and care teams should especially encourage minority populations to consider advance care planning so those groups receive greater goal-concordant care.