Predictors of Readiness to Engage in Advance Care Planning Among Older Adults With Serious Illness: Baseline Findings From the EQUAL ACP Study.

BACKGROUND: Advance care planning (ACP) supports seriously ill individuals in identifying and communicating their values and preferences for future care. However, disparities in ACP engagement persist, particularly among African American older adults. This study examined racial differences and predictors of readiness to engage in ACP among seriously ill African American and White older adults.
METHODS: This cross-sectional analysis used baseline data from the EQUAL ACP cluster randomized trial testing two ACP interventions. Participants included 792 community-dwelling, non-Hispanic African American (n = 428) and White (n = 364) adults aged 65 and older with serious illness or multimorbidity, recruited from 10 primary care clinics across five Southern U.S. states. Readiness to engage in ACP was measured using a four-item scale assessing willingness to discuss and document care preferences. Predictor variables included religiosity, beliefs about death and dying, perceived discrimination and trust, provider communication, treatment preferences, and self-rated health. Mixed-effects regression models were used to examine predictors of ACP readiness in the overall sample and racial subgroups.
RESULTS: Overall ACP readiness did not significantly differ by race. Across racial groups, greater comfort discussing death was associated with greater ACP readiness. Among African American participants, frequent religious service attendance was associated with higher ACP readiness (mean difference = 0.28; 95% CI: 0.08-0.47). Among White participants, a preference for pain relief over life extension in their current health status was associated with higher readiness (mean difference = 0.25; 95% CI: 0.05-0.45). Trust in providers, experiences of discrimination, and ratings of provider communication were not significantly associated with ACP readiness.
CONCLUSION: Although mean readiness scores were similar, predictors varied by race. Religious attendance may facilitate ACP readiness among African American patients, while comfort-focused treatment preferences appear more influential among White patients. Culturally tailored strategies are needed to equitably support ACP engagement among older adults.