Table 3 Characteristics of included studies
First Author Year Country | Study Population (n) | Ethnic Group(s)a (%) | Disease Group/Clinician Type | Healthcare Location | Summary objectives and methods | JBI Critical Appraisal Scoreb | Gough WoEc,d | Primary measure | Secondary measure |
|---|---|---|---|---|---|---|---|---|---|
Beltran 2022 USA [42] | Patients (13) Relatives (10) | Latino (100%) | Cancer Heart disease Dementia COPD ALS Renal failure | Hospice | Qualitative semi-structured interviews to explore factors affecting Latino patients’ decisions to enrol in hospice care | 85% | H | Y | |
Braun 2010 USA [43] | HCPs (26) | Caucasian (42.3%) African American (30.7%) Hispanic (26.9%) | Generalists Sub-specialists | Medical centre | Focus group interviews to explore physician factors affecting end of life decision making | 89% | H | Y | |
Eneanya 2016 USA [44] | Patients (152) | Black (41.4%) White (58.6%) | End-stage kidney disease | Academic centres | Qualitative semi-structured interviews to explore racial variability in ACP | 100% | H | Y | |
Li 2021 Taiwan [45] | Patients (9) | Taiwanese /Indigenous (100%) | Cancer | Not reported | Case study approach to explore indigenous patients perceptions of ACP | 90% | H | Y | |
Lin 2020 Taiwan [46] | Patients (10) Carers (10) HCP (9) | Taiwanese (100%) | Cancer | Inpatient hospital | Mixed methods study (qualitative interview and quantitative review of medical records) to examine feasibility of culturally-sensitive ACP intervention | 95% | H | Y | |
Mack 2010 USA [47] | Patients (332) | Black (21.4%) White (78.6%) | Cancer | Varied cancer services/clinics | Longitudinal study to investigate end of life care disparities between “Black and White” patients | 90% | H | Y | |
Periyakoil 2015 USA [48] | HCP (1040) | Caucasian (48.7%) Latino-American (5.8%) African American (3.4%) Asian (33.6%) Mixed race & ethnicity (8.4%) | Multi-speciality doctors | Academic medical centre | Cross-sectional survey to identify clinician barriers to end of life conversations with ethnically diverse patients | 94% | H | Y | |
Pettigrew 2020 USA [49] | Patients & carers (431) | Carer: White (87.2%) African American (9.8%) Other (3%) Patient: White (88.2%); African American (10.2%); Other (1.6%) | Dementia | Dementia clinics | Cross-sectional survey to understand factors affecting ACP decision making in persons with dementia | 92.5% | H | Y | |
Rhodes 2015 USA [50] | HCPs (12) | Non-Hispanic White (83.3%) Non-Hispanic Black (8.3%) Other (8.3%) | Physician Nursing staff Social workers Chaplains | Hospice | Qualitative semi-structured interview to explore barriers to use of end of life care options with HCPs | 82.5% | H | Y | |
Shen 2016 USA [51] | Patients (117) | Latino (52.1%) Non-Latino/White (47.9%) | Cancer | Public hospital | Structured interviews to explore ethnic differences in the association between end of life discussions and DNR completion | 96.5% | H | Y | |
Ashana 2022 USA [52] | HCPs (74) | White (92.4%) Asian (7.6%) Black (1.5%) | Physicians Nurses Social workers Chaplains | Varied healthcare centres | Qualitative semi-structured interviews to identify populations less approached for ACP, in addition to clinician-level barriers and facilitators | 77.5% | M | Y | |
Burgio 2016 USA [53] | Patients (4891) | African American (34.5%) White (65.3%) | Cancer Dementia Heart disease Lung disease Kidney disease Liver disease | VA Medical centre | Retrospective review of medical records to explore differences between African American and White patients | 82.5% | M | Y | |
Cervantes 2017 USA [54] | Patients (20) | Latino (100%) | End-stage kidney disease | Outpatient haemodialysis centre | Semi-structured qualitative interviews to understand ACP preferences of Latino patients | 80% | M | Y | |
Cheung 2020 Hong Kong [55] | Patients (17) Relatives (13) | Chinese (100%) | Not reported | Palliative day care centre | Qualitative interviews and focus groups to explore barriers to ACP | 75% | M | Y | |
Frey 2014 New Zealand [41] | HCP (40) | New Zealand European (47.5%) Maori (7.5%) Pacific (7.5%) Asian (12.5%) Southeast Asian (17.5%) Other European (7.5%) | Staff nurse GP Anaesthetist Consultant | Palliative care services | Interviews and focus groups to explore HCP perspectives on the barriers to ACP | 75.5% | M | Y | |
Garrido 2014 USA [56] | Patients (606) | Non-Latino White (72.1%) Black (15.3%) Latino (12.5%) | Cancer | Outpatient clinics | Baseline interviews from a longitudinal study to identify intervention targets for reducing disparities in ACP | 75% | M | Y | |
Grill 2021 USA [57] | Patients (223) | African American (86.1%) Non-African-American (11.2%) | HIV | Hospital-based clinics | Cross-sectional survey to explore factors affecting HIV patients end of life preferences | 81.25% | M | Y | |
Jonnalagadda 2012 USA [58] | Patients (335) | Non-minority (59.1%) Black (20.8%) Hispanic (20%) | Lung cancer | Medical centres | Cross-sectional survey to evaluate differences between “minority and non-minority” patients with lung cancer | 80.75% | M | Y | |
Kirtane 2018 USA [59] | Patients (9468) | White (84.2%) Black (4.8%) Native American (1.2%) Asian (6.4%) Pacific Islander (0.5%) Hispanic (1.7%) Other/mixed race (1.1%) | Cancer | Medical centres | Retrospective cohort study and chart review to explore end of life outcome measures in “ethnic minority patients” | 88.75% | M | Y | |
Menon 2018 Singapore [60] | HCPs (33) Patients (15) Carers (13) | HCPs: Chinese (84%) Malay (3%) Indian (6%) Other (6%) Patients/Carers: Chinese (82.1%) Malay (7.1%) Indian (10.7%) | Doctors/nurses Not reported – ‘varied life limiting illnesses’ | ‘Varied healthcare centres’ | Qualitative interviews and focus groups to study patient, relative and HCP perspectives on ACP | 82.5% | M | Y | |
Periyakoil 2014 USA [61] | HCPs (1081) [2013 sample] | White/Caucasian (51.1%) Hispanic or Latino American (5.3%) African American (3.2%) Asian American (32.7%) Other (7.8%) | Doctors | (Training) Hospital | Online survey to determine clinician factors affecting advanced directives | 83.125% | M | Y | |
Phipps 2003 USA [62] | Patients (68) Carers (68) | Patients: African American (55.8%) White (44.2%) Carers: African American (52.9%) White (47.1%) | Cancer | Cancer centre | Structured interview to explore end of life preferences in terminally ill patients | 78.125% | M | Y | |
Rhodes 2017 USA [63] | HCPs (14) Patients (1) Carers (2) | African American (100%) | Dementia Cancer | Hospice | Semi-structured interviews (and focus groups) to explore perceptions of ACP among African Americans | 77.5% | M | Y | |
Sharma 2011 USA [64] | Patients (238) | White (63%) Black (32%) Other (5%) | Cancer | Hospital | Retrospective chart review to explore association between patient characteristics and ACP | 87.25% | M | Y | |
Shen 2020 USA [51] | Patients (20) Carers (9) | Patient: White/Latino (90%) Black (10%) Carer: White/Latino (66.7%) Other (33.3%) | Cancer | Outpatient cancer clinics | Qualitative interviews to explore patient and caregiver preferred ACP communication methods | 80% | M | Y | |
Smith 2007 USA [65] | Patients (803) | African American (14.3%) White (85.7%) | Cancer Heart disease COPD Renal disease | Not reported | Cross-sectional survey to explore how the patient-physician relationship impacts ACP for African American and White patients | 92.5% | M | Y | |
Smith 2008 USA [15] | Patients (449) | White (69.4%) Black (16.7%) Hispanic (13.8%) | Cancer | Cancer clinics | Cross-sectional structured interview to explore proposed mediators of racial differences in ACP | 80% | M | Y | |
Taylor 2015 USA [66] | Patients (189) | White (60%) Hispanic (20%) Black (16%) Asian (4%) | Cancer | Cancer centre | Retrospective chart review to identify disparities in uptake of end of life resources | 76% | M | Y | |
Ufere 2019 USA [67] | HCP (396) | White (63.1%) Asian (29.5%) Black (3%) Native Indian/ Native Hawaiian (0.8%) Other (3.5%) | Hepatologists Gastroenterologists | Hospital / Private practice | Cross-sectional survey to explore HCP perspectives on barriers to ACP discussions | 90% | M | Y | |
Zaide 2012 USA [68] | Patients (400) | White (47%) African American (35%) Asian (11%) | Cancer | Inpatient palliative care service | Retrospective chart review to explore how palliative care consultation impacts the rate of advanced directive completion | 87% | M | Y | |
Jung-Hwa 2021 Korea [69] | HCP (12) | Korean (58.3%) Korean-American (16.6%) White (16.6%) African American (8.3%) | Social workers | Hospital Day centres | Qualitative interviews to explore how social workers engage in ACP with a variety of patients | 77.5% | M | Y | |
Chiu-Chu 2019 Taiwan [70] | HCP (221) | Taiwanese (91.7%) Mainlander (3.7%) Hakka (3.2%) Aborigine (1.4%) | Nurses | Teaching hospital | Structured questionnaire to explore ACP within a hospice environment in Taiwan | 86.5% | M | Y | |
Wilkinson 2016 UK [71] | Patients (16) HCP (45) | Not reported (Discussing South Asian individuals) | End stage kidney disease | Hospitals | Action research methodology (including interview and focus groups) to explore issues relating to patient recruitment for research | 82.5% | M | Y | |
Foliaki 2020 New Zealand [72] | Patients (7) Carers (15) HCP (33) | Pacific (93.3%) Non-Pacific (6.7%) | Cancer PC specialists GP Nursing staff | Hospice | Semi-structured interviews to explore perspectives on barriers to palliative care among Pacific populations | 80% | M | Y | |
Omondi 2017 Kenya [73] | Patients (216) | African (69.9%) Asian (22.2%) Caucasian (6%) Other (2%) | Cancer ESKD Heart failure COPD | Hospital | Retrospective chart review to explore the amount of patients with advanced directives and factors affecting completion | 80.6% | M | Y |