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. 2025 May 6;9(6):igaf041.
doi: 10.1093/geroni/igaf041. eCollection 2025.

Results of a Culturally Tailored Advance Care Planning Intervention for American Indian Peoples: A Quasi-Experimental Waitlist-Controlled Trial

April Schweinhart  1 , R Turner Goins  2 , Elizabeth Anderson  3
Affiliations

Results of a Culturally Tailored Advance Care Planning Intervention for American Indian Peoples: A Quasi-Experimental Waitlist-Controlled Trial

April Schweinhart et al. Innov Aging. .

Abstract

Background and objectives: American Indian and Alaska Native peoples have disproportionately low rates of advance care planning (ACP). To address this problem, we culturally tailored and evaluated an intervention for ACP to the needs of a specific American Indian Tribe. The goal of our study was to examine the culturally tailored Make Your Wishes About You (MY WAY) ACP intervention with respect to 5 ACP outcomes: barriers, facilitators, readiness, self-efficacy, and notarized advance care plan completion.

Research design and methods: We engaged Tribal community members in a quasi-experimental, waitlist-controlled trial design to test the effects of the program. Our sample included 2, self-selected groups totaling 113 participants. Data were collected via interviewer-administered surveys with participants on 3 occasions. The intervention group completed an intervention baseline survey, postprogram survey, and a follow-up survey 6 months after the intervention, and the waitlist comparison group completed a control baseline survey, intervention baseline survey, and postprogram survey.

Results: Our results showed that, on average, ACP barriers decreased, and facilitators, readiness, self-efficacy, and notarized advance care plan completion increased postintervention for participants who completed the ACP program. These changes were significantly greater for the intervention group than the waitlist comparison group and were sustained at the 6-month follow-up for the intervention group. In total, 76 more individuals completed their notarized advance care plans by the end of program participation than at intervention baseline, a 79.1% increase.

Discussion and implications: The culturally tailored program was found to increase readiness and self-efficacy for ACP and increased the likelihood of a participant having a notarized advance care plan postprogram. Our study affects clinical and public health practice by testing a program that is responsive to cultural values, beliefs, and practices and shown to increase ACP among American Indian peoples.

Clinical trial registration: NCT05304117.

Keywords: Advance directive; Barriers and facilitators; End-of-life; Readiness; Self-efficacy.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Consort flow diagram.
Figure 2.
Figure 2.
Change in ACP barriers and facilitators. ACP = advance care planning.
Figure 3.
Figure 3.
Change over time in ACP outcomes for intervention and waitlist comparison sample and intervention group follow-up. ACP = advance care planning.
See this image and copyright information in PMC

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