RPD216 - Barriers and Facilitators to Advance Care Planning among Latino Individuals with Decompensated Cirrhosis

Key Message : Our aim was to understand why Latino adults with decompensated cirrhosis experience greater disparities in advance care planning. We discovered that promoting dialogue regarding religion, cultural identity, personal health experiences, emotional readiness, and family dynamics may support ACP engagement in this population. Clinician normalization of ACP is also critical.

Abstract:

Background: Latino individuals are disproportionately affected by cirrhosis, and those with advanced liver disease are less likely to be listed for liver transplantation or complete advance directives compared to White individuals. To inform development of interventions intending to reduce disparities in advance care planning (ACP), this study aims to describe the context of barriers and facilitators to ACP from the perspective of Latino adults with decompensated cirrhosis.

Methods: We conducted face-to-face, audio-recorded, semi-structured interviews with 42 patients across three LT centers in Los Angeles. We included English-speaking patients with ≥ 1 portal hypertension complication and MELD-Na ≥ 15, purposively sampled according to transplant status. Thematic analysis was used to analyze transcripts of 14 participants who self-identified as Latino.

Results:
Three levels of themes emerged: patient, patient-caregiver, and patient-clinician. Patient: Personal health experiences often motivated engagement in ACP, and religion offered a meaningful framework for coping with illness and feelings about death. For others, internal fears regarding death delayed ACP discussions. Patients described avoidance of decision-making due to discomfort with envisioning decline. Patient-Caregiver: For some, ACP was undertaken to reduce emotional and financial burden on loved ones, often as a consequence of prior experience. Cultural values around caregiving facilitated discussions, while emotional tension in family and practical factors complicated discussions. Patient-Clinician: Though ACP documentation was mentioned in clinical settings, the value was not often understood by patients. Patients were not certain as to whose role it was to initiate end-of-life discussions and when the right timing would be. Clinician silence about end-of-life discussions was also interpreted as a cue that the patient was stable. (Table)

Conclusion: Normalizing ACP conversations in the clinical setting is critical. Promoting dialogue in the context of religion, cultural identity, personal health experiences, emotional readiness, and family dynamics may support more meaningful ACP engagement in this population.

References: 1.Setiawan, V.W., Stram, D.O., Porcel, J., Lu, S.C., Le Marchand, L. and Noureddin, M., 2016. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology, 64(6), pp.1969-1977.
2. Warren, C., Carpenter, A.M., Neal, D., Andreoni, K., Sarosi, G. and Zarrinpar, A., 2021. Racial disparity in liver transplantation listing. Journal of the American College of Surgeons, 232(4), pp.526-534.
3.Patel, A.A., 2020. Advance Care Planning in Patients with Decompensated Cirrhosis at Liver Transplant Centers. University of California, Los Angeles.