American Muslim Engagement with Advance Care Planning: A Cross-Sectional Study
Raudah Yunus; Rosie Duivenbode; and Aasim Padela, MD, MSc, FACEP, Professor of Emergency Medicine, Bioethics and the Medical Humanities, Medical College of Wisconsin
Background and objectives: Advance Care Planning (ACP) is a platform for describing one’s preferences for medical care that is concordant to one’s goals and values. Despite the growing research about ACP among ethnic minorities in the US, studies that explore Muslim attitudes towards ACP and how religiosity affects ACP engagement among the Muslim populations are relatively scarce. Our study aims to: a) examine the levels of ACP engagement among Muslim adults; b) measure associations between socio-demographic and religiosity characteristics and ACP engagement, and; c) determine the independent predictors for ACP engagement.
Methodology: This was a cross-sectional study conducted in Chicagoland and Washington DC areas. Respondents were recruited using convenience sampling across four mosques – two located in each area respectively – that served Muslims of ethnically diverse backgrounds. Religiosity characteristics were assessed using the 5-item Duke University Religion Index (DUREL-5) and the Psychological Measure of Islamic Religiousness (PMIR). ACP engagement was measured with the 4-item version of the ACP Engagement Survey (with additional 2 items). Descriptive, bivariate and Generalized Linear Model (GLiM) analyses were performed using SPSS 28.0 for Windows.
Results: Out of 152 respondents, approximately two-thirds were in the pre-contemplation stage of ACP. Bivariate analyses showed that ACP engagement was associated/correlated with age (r=0.29, p<0.01), ethnic group (r=-0.19, p=0.02), duration of stay in the US (r=0.35, p<0.01) and country of birth (r=-0.14, p=0.10). When each ACP item was treated as a separate outcome, positive religious coping was correlated with 3 ACPES items (r=0.18-0.20, p<0.05) whereas negative religious coping was (inversely) correlated with 1 item (r=-0.15, p=0.08). GLiM analyses however demonstrated no association between religiosity characteristics and ACP engagement; independent predictors were ethnic group (β=-0.39, CI:-0.70,-0.07), country of birth (β=0.29, CI:0.02,0.56) and duration of stay in the US (β=-0.85, CI:-1.51,-0.19).
Implication/conclusion: We found no relationship between religiosity characteristics and ACP engagement. This can be attributed to the diverse interpretations and multiple expressions of religiosity, probable deficiency in current conceptualization of religiosity variable(s), and the lack of appropriate measurement tool that is specific to ACP and EOL care. Our findings can assist health care providers (HCP) in devising a more nuanced communication strategy while initiating ACP conversations with Muslim patients. They are also useful for the delivery of individualized care and providing greater religious accommodations, while enhancing clarity for patient decision making. For future research, we recommend the development of measurement tools for religiosity that are specific to ACP/EOL care and newer religiosity constructs that can better elucidate ACP behaviors. Mixed-methods research can produce more robust data and provide a deeper insight into complex phenomena such as religiosity toward the end of life.
Methodology: This was a cross-sectional study conducted in Chicagoland and Washington DC areas. Respondents were recruited using convenience sampling across four mosques – two located in each area respectively – that served Muslims of ethnically diverse backgrounds. Religiosity characteristics were assessed using the 5-item Duke University Religion Index (DUREL-5) and the Psychological Measure of Islamic Religiousness (PMIR). ACP engagement was measured with the 4-item version of the ACP Engagement Survey (with additional 2 items). Descriptive, bivariate and Generalized Linear Model (GLiM) analyses were performed using SPSS 28.0 for Windows.
Results: Out of 152 respondents, approximately two-thirds were in the pre-contemplation stage of ACP. Bivariate analyses showed that ACP engagement was associated/correlated with age (r=0.29, p<0.01), ethnic group (r=-0.19, p=0.02), duration of stay in the US (r=0.35, p<0.01) and country of birth (r=-0.14, p=0.10). When each ACP item was treated as a separate outcome, positive religious coping was correlated with 3 ACPES items (r=0.18-0.20, p<0.05) whereas negative religious coping was (inversely) correlated with 1 item (r=-0.15, p=0.08). GLiM analyses however demonstrated no association between religiosity characteristics and ACP engagement; independent predictors were ethnic group (β=-0.39, CI:-0.70,-0.07), country of birth (β=0.29, CI:0.02,0.56) and duration of stay in the US (β=-0.85, CI:-1.51,-0.19).
Implication/conclusion: We found no relationship between religiosity characteristics and ACP engagement. This can be attributed to the diverse interpretations and multiple expressions of religiosity, probable deficiency in current conceptualization of religiosity variable(s), and the lack of appropriate measurement tool that is specific to ACP and EOL care. Our findings can assist health care providers (HCP) in devising a more nuanced communication strategy while initiating ACP conversations with Muslim patients. They are also useful for the delivery of individualized care and providing greater religious accommodations, while enhancing clarity for patient decision making. For future research, we recommend the development of measurement tools for religiosity that are specific to ACP/EOL care and newer religiosity constructs that can better elucidate ACP behaviors. Mixed-methods research can produce more robust data and provide a deeper insight into complex phenomena such as religiosity toward the end of life.