More than half of sexual and gender minority (SGM) adults experience some form of discrimination in health care; for those who are transgender or gender nonconforming, the percentage increases to 70%.¹ SGM communities face multilevel stressors, including family rejection, financial insecurity, and anxiety over concealment of their sexual orientation and/or gender identity; the stress of discrimination toward SGM individuals can reduce life expectancy by up to 12 years.² SGM people have been left out of the recent conversations regarding the outcomes (or lack thereof) of advance care planning (ACP)³ because there is little evidence, data, or stories from SGM communities about the value (or not) of ACP.⁴ While ACP may positively affect quality end-of-life (EOL) care and ensure preferences are aligned,⁵ ACP among SGM is not well understood, and patient-centered approaches for this population are lacking.

Youth can be valuable partners in community health improvement efforts. Latino youth from Lawrence, MA were engaged in research and health promotion over an 11-month period. Utilizing their knowledge of the community, youth assessed local parks and carried out evidence-based health promotion efforts to communicate community resources to encourage physical activity, nurture community ownership of parks, and advocate for park improvements. Health promotion efforts can engage youth in strategies to address critical public health issues by leveraging their unique perspective and distinct location within communities. The communications developed by the youth were distributed within the community, benefiting residents directly. Youth were motivated to engage in the project by a sense of civic obligation, and upon completing the project, they expressed that they had gained research and communication skills and were inspired to continue to support their community. Youth engagement in applied research and health promotion at the local level can provide a foundation for community health improvement efforts that are relevant for distinct communities, while fostering the positive development of youth, and nurturing community-driven efforts to help create a healthier environment.

Background: African American men are at a higher risk of developing and dying from prostate cancer compared to white men. The serum prostate-specific antigen (PSA) screening test has a high risk of false-positive results and overdiagnosis; therefore, it is not routinely recommended. Rather, men are encouraged to make individualized decisions with their medical providers, after being fully informed about its potential benefits, limitations, and risks. Objective: This study aimed to describe the development and pilot testing of an interactive Web-based decision aid (DA; Prostate Cancer Screening Preparation [PCSPrep]) for African American men, designed to promote informed decision making for prostate cancer screening. Methods: Four focus groups (n=33) were conducted to assess men’s reactions to DAs developed in prior studies and gather information to modify the content and format. The pilot test employed a pre-posttest evaluation design. A convenience sample of 41 men aged 45-70 years with no history of prostate cancer was recruited from community settings. Participants completed online surveys before and after using PCSPrep that assessed prostate cancer screening knowledge, decision self-efficacy, decisional conflict, and preparation for decision making. Results: Use of PCSPrep was associated with a significant increase in prostate cancer knowledge (49% vs 62% correct responses; P<.001), and men also experienced less decisional conflict (24 vs 15 on a scale of 0-100; P=.008). No changes in self-efficacy about decision making or screening preferences were observed. Most men (81%) reported that using PCSPrep prepared them to make informed decisions in partnership with their provider. Conclusions: PCSPrep was an acceptable DA that improved men’s knowledge, reduced decisional conflict, and promoted the perception of being prepared for shared decision making. Further research is needed to test the DA in a larger randomized trial.

Medicare beneficiaries with high medical needs can benefit from Advance Care Planning (ACP). Medicare reimburses clinical providers for ACP discussions, but it is unknown whether high-need beneficiaries are receiving this service. To compare rates of billed ACP discussions among a cohort of high-need Medicare beneficiaries with the non-high-needs Medicare population. Retrospective analysis of Medicare Fee-for-Service (FFS) claims in 2017 comparing high-need beneficiaries (seriously ill, frail, ESRD, and disabled) with non-high need beneficiaries. Nationally representative FFS Medicare 20% sample Medicare beneficiaries were assigned to one of the following classifications: seriously ill (65+), frail (65+), seriously ill & frail (65+); non-high need (65+); end stage renal disease (ESRD) or disabled (<65). All participants had data available for years 2016–2017. Receipt of a billed ACP discussion, CPT codes 99497 or 99498. Rates of billed ACP visits were compared between high-need patients and non-high-need patients. Rates were adjusted for the 65+ population for sex, age, race/ethnicity, Charlson comorbidity index, Medicare/Medicaid dual eligibility status, and Hospital Referral Region. Among the 65+ groups, those most likely to have a billed ACP discussion included seriously ill & frail (5.2%), seriously ill (4.2%), and frail (3.3%). Rates remained consistent after adjusting (4.5%, 4.0%, 3.1%, respectively). Each subgroup differed significantly (p < .05) from non-high need beneficiaries (2.3%) in both unadjusted and adjusted analyses. Among the <65 high need groups, the rates were 2.7% for ESRD and 1.3% for the disabled (the latter p < .05 compared with non-high needs). While rates of billed ACP discussions varied among patient groups with high medical needs, overall they were relatively low, even among a cohort of patients for whom ACP may be especially relevant.