Background Advance Care Planning (ACP) is vital to ensure patients’ wishes are respected in healthcare decisions, particularly in the context of palliative care.¹ ACP improves outcomes for patients and their families.^{2 3} However, there is limited knowledge of ACP prevalence among Culturally and Linguistically Diverse (CALD) populations, especially in community palliative care settings.^{4 5}

Aims The primary aim was to determine the prevalence of Enduring Power of Attorney (EPOA) and Advance Health Directive (AHD) within CALD populations versus general population receiving community specialist palliative care services (CSPCS). The secondary aims were to evaluate the prevalence of the above documents 6 months post referrals to a community specialist palliative care service and identify factors influencing completion.

Methods An observational retrospective cohort study was conducted on patients referred to a major metropolitan CSPCS between 1st January 2022 to 1st January 2023. Data on EPOA and AHD presence, clinical and demographic factors were collected. Statistical analyses compared groups with different cultural and linguistic backgrounds and assessed influencing factors (table 1).

Results Of 576 eligible patients, 20% were classified as being in a CALD population, 69% were in progressive palliative care phases (phase 2–4) and 42% had died within 6 months following referral. No significant difference in EPOA prevalence between CALD groups (12–19%) versus the general population (23%)(p = 0.2). AHD prevalence was significantly lower in CALD populations (3–4%) compared to the general population (13%) (p = 0.017). Minimal increases in the presence of each document were observed in both groups 6 months post-referral. EPOA uptake is negatively associated with progressive palliative care phases (OR 0.058, 95% CI 0.38–0.87, p = 0.009) and regional geographical distribution (OR 0.53, 95% CI 0.29–0.90, p = 0.024) (tables 2–7).

Conclusions There are significant disparities in ACP uptake amongst CALD populations. Marginal increments observed post-referral underscore the critical need for early proactive ACP discussions. Enhanced healthcare provider training and targeted interventions addressing cultural and linguistic barriers are essential for achieving equitable uptake of ACP.

References

1. Sudore R, Lum H, You J, Hanson L, Meier D, Pantilat S, et al. Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi Panel (S740). Journal of Pain and Symptom Management. 2017 Feb;53(2):431–2.

2. Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliative Medicine. 2014 Mar 20;28(8):1000–25.

3. Service provision in Australia: A planning guide [Internet]. Palliative Care Australia [updated Jul 2015; cited 6 May 2024]. Available from: https://palliativecare.org.au/wp-content/uploads/2015/07/Palliative-Care-Service-Provision-in-Australia-a-planning-guide.pdf

4. White BP, Willmott L, Tilse C, Wilson J, Ferguson M, Aitken J, et al. Prevalence of advance care directives in the community: A telephone survey of three Australian states. Internal Medicine Journal. 2019 Oct;49(10):1261–7.

5. Sinclair C, Sellars M, Buck K, Detering KM, White BP, Nolte L. Association between region of birth and advance care planning documentation among older Australian migrant communities: a multicenter audit study. The Journals of Gerontology: Series B. 2020 Aug 17;76(1):109–20.