Blacks and whites had longitudinal increased rates of advance directive completion, but the same was not true for Hispanics, a recent study found.1 Analyzing data from 7,177 decedents, researchers determined that:

• less than half (46%) had completed an advance directive (whites 51.7%, Hispanics 18%, blacks 15%);

• of blacks completing an advance directive, 23.8% elected prolonged care, compared with 13.3% of Hispanics and 3.3% of whites.

“Our hope is that results from this study will encourage communication between healthcare professionals, families, and patients to support end-of-life care that is aligned with the values of patients as individuals,” says Jaclyn Portanova, MSG, RN, the study’s lead author and a predoctoral fellow at University of Washington School of Nursing in Seattle.

Ethnic differences in rates of advance directive completion and in care choices have been well-documented over the past decade. “With increased focus on expanding access to palliative care, improving patient-centeredness in care, and attention to increasing rates of advance directive completion, we wanted to see if there has been any longitudinal change over the past decade,” says Susan Enguidanos, PhD, MPH, another of the study’s authors. Enguidanos is an associate professor of gerontology at University of Southern California, Los Angeles.

Hispanics without significant others were more likely to complete advance directives than those with a significant other. “This attests to the reliance on family for care decision-making among Hispanics,” Enguidanos says.

The continued differences in advance directive completion between whites and non-whites point to the need for providers to engage minority patients and their family members in these discussions, says Enguidanos. Once physicians identify patient preferences for care, these preferences can be charted and referred to in the event the patient needs healthcare decision-making in the future.

Previous research shows that physicians are less likely to have advance care planning and hospice discussions with minority patients.2,3 “Increased attention to bridging this gap is needed,” says Enguidanos.


1. Portanova J, Ailshire J, Perez C, et al. Ethnic differences in advance directive completion and care preferences: What has changed in a decade? J Am Geriatr Soc 2017; 65(6):1352-1357.

2. Fischer SM, Sauaia A, Min SJ, et al. Advance directive discussions: lost in translation or lost opportunities? J Palliat Medi 2012; 15(1): 86-92.

3. Huskamp HA, Keating NL, Malin JL, et al. Discussions with physicians about hospice among patients with metastatic lung cancer. Arch Intern Med 2009; 169(10): 954-962.


• Susan Enguidanos, PhD, MPH, Associate Professor of Gerontology, University of Southern California, Los Angeles. Phone: (213) 740-9822. Email:

• Jaclyn Portanova, MSG, RN, NINR Predoctoral Fellow, UW School of Nursing, Seattle. Email: