Black Nursing Home Residents More Likely to Watch Advance Care Planning Video

J Am Geriatr Soc. 2020 Mar;68(3):603-608. doi: 10.1111/jgs.16237. Epub 2019 Oct 29.


Background/objectives: This study aims to identify resident characteristics associated with being offered and subsequently shown an advance care planning (ACP) video in the Pragmatic Trial of Video Education in Nursing Homes (PROVEN) and if differences are driven by within- and/or between-facility differences.

Design: Cross-sectional study, from March 1, 2016, to May 31, 2018.

Setting: A total of 119 PROVEN intervention nursing homes (NHs).

Participants: A total of 43 303 new NH admissions.

Measurements: Data came from the Minimum Data Set and an electronic record documenting whether a video was offered and shown to residents. We conduct both naïve logistic regression models and hierarchical logistic models, controlling for NH fixed effects, to examine the overall differences in offer and show rate by resident characteristics.

Results: In naïve regression models, compared to white residents, black residents are 7.8 percentage point (pp) (95% confidence interval [CI] = -9.1 to -6.5 pp) less likely to be offered the video. These differences decrease to 1.3 pp (95% CI = -2.61 to -0.02 pp) when accounting for NH fixed effects. In fully adjusted models, black residents compared to white residents were 2.1 pp more likely to watch the video contingent on being offered (95% CI = 0.4-3.7 pp). Residents with cognitive impairment were less likely to be offered and shown the video.

Conclusions: After controlling for NH fixed effects, there were smaller racial differences in being offered the video, but once offered, black residents were more likely to watch the video. This suggests that black residents are receptive to this type of ACP intervention but need to be given an opportunity to be exposed. J Am Geriatr Soc 68:603-608, 2020.

Keywords: advance care planning; end-of-life care; health disparities; long-term care.