Abstract
Outcomes
1. Determine whether the COVID-19 pandemic changed patients’ perceived willingness to talk about advance care planning and preferences for care in the event of severe COVID-19 illness
2. Determine whether the preferences for care changed during COVID-19 for Black and White patients
Importance
Rates of advance care planning (ACP) are lower and preferences for life-prolong therapies are higher among Black patients than White patients.
Objective
To examine whether the COVID-19 pandemic, which has disproportionately affected Black patients, has changed racial differences in beliefs about ACP or preferences for end-of-life (EOL) care.
Methods
We used data from EQUAL ACP, a comparative effectiveness trial of 2 ACP interventions in seriously ill patients ≥65 years old seen in 10 primary care clinics in the South. We asked about COVID-19-related ACP and preferences for care. We used chi-square tests to examine racial differences in responses.
Results
The sample included 164 Black and 109 White patients. The mean age was 75 years; 63% were female. Similar proportions of Black and White patients (15.9% and 16.8%) reported being “more willing to talk to family/friends/doctors” about wishes for medical care as a result of the pandemic, although most (81.7% and 82.6%) reported “no change in willingness” (p = 0.85). A greater proportion of White than Black patients (26.6% vs. 20.7%) reported talking to family or friends about their wishes for COVID-19-related medical care. There were significant racial differences (p < .001) in EOL care preferences in the event of severe COVID illness. Black patients (36% vs. 12%) were more likely to want all treatments to keep them alive as long as possible, and White patients (75% vs. 55%) were more likely to only want a time-limited trial of life-prolonging measures.
Conclusion
In this sample, most patients reported that the COVID-19 pandemic has not changed their wiliness to participate in ACP discussions. Black patients were more likely than White patients to want life-prolonging measures in the event of severe COVID illness.
Impact
Further studies should identify disparities in the quality of palliative care for patients with COVID-19 and determine potential drivers.