Racial and Ethnic Differences in Advance Care Planning: Results of a Statewide Population-Based Survey

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Epidemiology | Health Services Administration | Health Services Research | Palliative Care | Race and Ethnicity


BACKGROUND: Few studies have focused on racial and ethnic differences in advance care planning other than advance directives among population-based samples of adults across the lifespan.

METHODS: Using data from a statewide random-digit dial telephone survey of adults 18 years or older (n = 1851), we investigated racial and ethnic differences in (1) designation of a healthcare agent (HCA); and (2) communication of goals, values, and preferences for end-of-life care with healthcare providers, a HCA, or other family members and friends.

RESULTS: Less than half (44%, 95% confidence interval [CI] = 41.3%-47.0%) of all participants had named a HCA. In multivariable analyses, participants who identified as Hispanic (adjusted odds ratio [aOR] = 0.4, 95% CI = 0.2-0.7) or non-Hispanic other (aOR = 0.6, 95% CI = 0.4-0.9) were less likely than non-Hispanic whites to have named a HCA. Only 14.5% (95% CI = 12.6%-16.5%) of all participants had ever had a conversation with a healthcare provider about their end-of-life care wishes, with no differences by race/ethnicity. Over half (53.9%, 95% CI = 51.0%-56.8%) of all participants reported having had conversations with someone other than a healthcare provider about their end-of-life wishes. In multivariable analyses, non-Hispanic whites were more likely than Hispanics (aOR = 0.5, 95% CI = 0.3-0.7), black/African Americans (aOR = 0.5, 95% CI = 0.3-0.9), and non-Hispanic others (aOR = 0.7, 95% CI = 0.5-1.0) to report having had such conversations.

CONCLUSIONS: Racial and ethnic minorities may be disadvantaged in the quality of care they receive if they have a serious illness and are unable to make decisions for themselves because most have not talked to anyone about their goals, values, or preferences for care.


advance care planning, advance directive adherence, cross-cultural comparison

DOI of Published Version



J Palliat Med. 2018 Apr 16. doi: 10.1089/jpm.2017.0374. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Journal of palliative medicine

PubMed ID


Related Resources

Link to Article in PubMed