Advance Care Planning Among People from Ethnic Minority and Non-Ethnic Minority Backgrounds with Poor-Prognosis Cancers: A Single-Site Retrospective Medical Record Review Study

Background/Objectives: Studies indicate inequity in uptake of advance care planning (ACP) for some groups of people from ethnic minority backgrounds. There is limited evidence of disparity in the uptake of ACP among people from ethnic minority and non-ethnic minority backgrounds experiencing cancer in Australia. This exploratory study aimed to fill this gap. Methods: A single-site retrospective medical record review study was conducted. Random sampling was employed to extract data from eligible medical records of patients from ethnic minority and non-ethnic minority backgrounds with a poor-prognosis cancer diagnosis. Results: A total of 102 records were reviewed: 52 patients from ethnic minority backgrounds and 50 from the general population. Any ACP communication was documented in 77 medical records, with no statistically significant difference between groups (χ2 = 0.12, p = 0.732). A total of 326 ACP communications were documented. ACP communication rates were lower among patients from ethnic minority backgrounds, across total, formal, and informal communications, although none of the differences were statistically significant. Most ACP communications occurred in the palliative care setting (193/326); only six instances of ACP were about religious or cultural preferences for care. More patients from ethnic minority backgrounds died in acute care hospitals (12/16) when compared to the general population cohort (4/16), with discordance observed between preferred and actual place of death. Conclusions: This descriptive exploratory study found that most patient records reviewed contained at least one documented ACP communication. Whilst the rate of ACP was lower among people from ethnic minority backgrounds when compared to those from the general population, this difference was not statistically significant. Informal ACP communication was documented less frequently compared to formal ACP. Co-designed training and resources may assist cancer care clinicians in initiating timely and culturally appropriate ACP communication. Early referral to palliative care is recommended.