Project 3: Geographical and Familial Factors in Engagement of Advance Directives




Li, Jessie
Liu, Tyler
Nokta, Nyla
Shah, Ahaan
Wang, Arthur

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George Mason University

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Background: Multiple studies have investigated the factors influencing the completion of Advance Care Planning (ACP) in the United States of America [1][2]. ACP involves preparing and discussing future medical care when the patient is incapacitated in some way so that they retain some autonomy of their decisions even when they are unable to communicate effectively [3][4]. Previous studies have compared rural and urban nursing home residents and found that rural nursing home residents were more likely to have advance directives in place and less likely to experience extended hospitalizations or intensive care stays compared to their urban counterparts [5]. Between urban and rural patients with Physician Orders for Life-Sustaining Treatment forms, orders for full treatment are less prevalent among rural patients, with a preference towards DNR and limited intervention [6]. However, the findings on rural vs. urban are not consistent. Another line of research has examined racial disparities, revealing that White/non-Hispanic residents were over twice as likely as Black residents to have documented advance directives, with county-facility characteristics accounting for a significant portion of this difference. Additionally, regional variations in Medicare spending have been linked to higher rates of ACP engagement [7][8]. Positive interactions, emotional support, and encouragement from family members play significant roles in motivating patients to undertake ACP [2][9] leading to more appropriate care during their end-of-life phase. Conversely, strained relationships characterized by criticism or lack of support may discourage individuals from engaging in ACP. Objective: The objective of this study was to determine the influence of geographical and familial factors on advance directive (AD) engagement in the United States.