Social work researcher explores treatment goals at end of life for older African Americans

Karen Bullock, Ph.D. has been awarded a Diversity Supplement Grant from NIH to explore treatment goals at end of life for older African Americans. As the principal investigator of the grant, Dr. Bullock will partner with a geriatrician at Yale University to carry out the study. This research supplements an RO1 grant awarded to Dr. Terri Fried at Yale University. In order to examine race as a primary variable in explaining end-of-life care decisions across groups, African American older adults in Hartford will be recruited to participate in the research, which will supplement the data on African American older adults in the New Haven area to increase racial diversity among research participants of RO1 research grant.

Advance directives are mechanisms that can be used to help patients receive optimal care at end of life. Individuals who engage in advance care planning (ACP) and use these tools to improve communication regarding care to be delivered or withheld are said to experience better care at end of life than those patients who do not complete advance directives. Unfortunately, Black patients who tend to have higher morbidity and mortality rates than their White counterparts are less likely to engage in advance care planning and to completion of advance directives than their White counterparts. Although meeting patients’ treatment preferences is a core tenet of quality end-of-life care, these preferences are frequently not met.  A necessary first step to meeting preferences is to improve advance care planning, the process by which patients express their preferences for future care in the case that they can no longer participate in decision-making. Few studies have sought to understand these racial differences in end-of-life care decision making. Dr. Karen Bullock’s previous research has documented racial differences in attitudes toward advance directives across racial groups. Her present research applies a model of health behavior change to ACP in order to determine the components, dimension, and scope of potential interventions to improve ACP.

To better understand why African Americans tend to under-utilize advance directives, it is imperative to include them as research participants in the exploration of treatment goals at end of life. “Because African Americans are less likely than their White counterparts to participate in medical research, our challenge to identify, recruit and enroll them in the study is one which NIH supports.” Dr. Bullock also says, “Fortunately, I have a number of African American community partners with whom I have established relationships over the years, who are willing and ready to assist in carrying out the research.”

“Ultimately, the intent of the research on Treatment Goals at the End-of-Life: The Role of Race in Advance Care Planning Decisions is to change care at the end of life to be more consistent with patients’ preferences.”  The intermediate goal is to improve the process of ACP.  In order to achieve these objectives, the immediate goal of this research is to apply models of health behavior change to ACP in order to determine the components, dimension, and scope of potential interventions to improve advance care planning.