The Need for Culturally Tailored Advance Care Planning

June 17, 2022

In any given moment, a medical crisis could result in a patient's inability to make their own health care decisions. Advance care planning (ACP) is an important step to ensure that a person voices their preferences and receives the medical care desired.  However, despite its significant importance and known benefits, the completion rate for advance directives is approximately one-third among the general population in the United States. 

Growing evidence suggests an even lower engagement in ACP among ethnic minorities in the U.S. Ethnicity and race provides important cultural context about how individuals view life decisions and can greatly influence their end-of-life (EOL) goals and preferences. ​​Given that engagement in ACP contributes to higher quality of care, it logically follows that lower engagement in ACP among minorities likely contributes to health disparities.

3 Barriers to ACP Conversations in Minorities
The most common barriers to ACP conversations among minorities include:

  • Language proficiency    
  • Low health literacy
  • Lack of culturally and/or linguistically appropriate materials 

It is possible to overcome these barriers but this can cost clinicians increased time and resources to develop the cultural competence required to have these ACP conversations. 

There is a great need for more effective communication as it relates to ACP, which includes education that is culturally sensitive and documents that are available in different languages. It is also important to incorporate an individual’s cultural values and priorities into ACP, determining who the patient wants involved in the ACP conversations.

Some ethnic groups generally lack knowledge of advance directives and EOL treatment options and are therefore less likely to support advance directives as a method of identifying and communicating their care goals and wishes.

Research has indicated that ACP discussions may improve knowledge of advance directives and have been shown to be associated with higher completion rates of Do Not Resuscitate (DNR) orders, less aggressive medical care near death, and earlier hospice referrals.  

Development of culturally tailored and language-appropriate tools that promote patient-centered ACP in minority or non-English speaking individuals is important to ensure that patients receive information that they can understand to ensure optimal decision making surrounding their future care. 

Culturally Tailored Advance Care Planning 

Iris’ Comprehensive Advance Care Planning (CACP) program helps address some of these barriers to deliver personalized care planning conversations and education to minorities.  By utilizing bilingual facilitators and translation services as needed, Iris is able to deliver personalized CACP conversations and education to patients and their families. 

Iris facilitators address potential barriers by:

  • Utilizing bicultural and bilingual facilitators and translation services to deliver personalized care planning conversations and education to individuals; 
  • Being culturally aware and partnering with the individual to understand their unique perspectives on the topics;
  • Communicating in clear and concise methods to ensure understanding of the treatment options and information so patients can make informed decisions about their future care; and 
  • Guiding individuals through the documentation process step-by-step, adjusting for comprehension levels to enhance understanding.

Additionally, Iris offers documentation in 26 languages using a user-friendly advance directive written in nontechnical, simple language. This documentation includes identification of a health care proxy, preferences for medical and nonmedical treatment, comfort care, and one’s spiritual and interpersonal needs. 

Proven Results Serving Minority Medicare Patients

Iris recently worked with a health care organization to deliver CACP services to their Medicare population across its vast provider network. This work was particularly unique because of the diverse population served, with approximately 51% of the patient population having a native language other than English. 

Iris served this patient population through the use of bilingual facilitators and interpreters to support a wide variety of native languages. By having support for multiple languages, Iris was able to provide CACP attuned with cultural sensitivity. 

As a result, the enrollment and document completion rates of non-English speaking patients mirrored that of English speaking patients. The high proportion of patient engagement in discussion and document completion in the CACP program demonstrated that, if performed in a culturally attuned manner, clinicians can tip the scale in helping patients from diverse backgrounds comfortably engage in CACP and EOL conversations.

Table 1: Advance Directive Documents Generated by Iris










Understanding and addressing communication and language needs, as well as cultural beliefs are essential to successful delivery of high quality care plans. Health care teams can provide the best care if they fully understand what is important to an individual and where they are coming from, especially in regard to treatment choices and follow-through with medical recommendations.

Practices that make culturally attuned ACP part of their population health strategy may improve quality of care delivered to patients while better managing and allocating health care resources. If you’d like to see how Iris can help your practice offer high-quality care planning to your diverse patient population, get in touch with Iris today.