Health Literacy, Spiritual Coping & the Completion of Advance Directives Following a Culturally Sensitive Educational Intervention

Based the prior investigations into disparities in advance care planning (ACP) among the African American population, it appears there is a need to identify culturally sensitive educational tools to increase knowledge and awareness within these areas of deficit. This study intended to test a culturally sensitive intervention designed to increase engagement in ACP, and examine variables impacting the completion of advance directives. Health literacy and religious coping were evaluated to determine their impact on intention to engage in advance care planning. It was predicted that religious coping would serve as a barrier to completion of advance directives. The sample consisted of 56 African American breast, lung, prostate, and colon cancer patients. The primary outcome measure was the Transtheoretical Stages of Change Model. Results found that the intervention was successful in increasing change in intention to complete ADs at the 1-month time point (B = -0.83, t(47) = -2.79, p = .007). However, the intervention was not found to be effective for increasing change in intention to assign an MPOA at the 1-month time point (B = -0.24, t(52) = -0.65, p = .522). Health literacy did not predict change in intent. Although positive religious coping was highly prevalent within the current study sample, results of the moderator analysis yielded a non-significant regression equation for both AD and MPOA consideration. The results of this study further highlight the importance of continued efforts towards addressing preferences in ACP.