• Karen Bullock.
• School of Social Work, University of Connecticut, West Hartford, Connecticut 06117, and The Braceland Center for Mental Health and Aging, Institute of Living, Hartford Hospital, Hartford, Connecticut, USA. karen.bullock@uconn.edu
• J Palliat Med. 2006 Feb 1; 9 (1): 183195183-95.

BackgroundStudies show that African Americans are less likely than other ethnic groups to complete advance directives. However, what influences African Americans' decisions to complete or not complete advance directives is unclear.MethodsUsing a faith-based promotion model, 102 African Americans aged 55 years or older were recruited from local churches and community-based agencies to participate in a pilot study to promote advance care planning. Focus groups were used to collect data on participants' preferences for care, desire to make personal choices, values and attitudes, beliefs about death and dying, and advance directives. A standardized interview was used in the focus groups, and the data were organized and analyzed using NUDIST 4 software (QRS Software, Victoria, Australia).ResultsThree fourths of the participants refused to complete advance directives. The following factors influenced the participants' decisions about end-of-life care and completion of an advance directive: spirituality; view of suffering, death, and dying; social support networks; barriers to utilization; and mistrust of the health care system.ConclusionThe dissemination of information apprises individuals of their right to self-determine about their care, but educational efforts may not produce a significant change in behavior toward completion of advance care planning. Thus, ongoing efforts are needed to improve the trust that African Americans have in medical and health care providers.

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