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Discussing End-of-Life Decision Making: Views of Racially and Ethnically Diverse Physicians
Braun UK, Ford ME, McCullough L, Beyth RJ. Discussing End-of-Life Decision Making: Views of Racially and Ethnically Diverse Physicians. [Abstract]. The Journal of Nutrition, Health & Aging. 2006 Aug 1; 10(4):332.
Previous studies have shown differences in preferences for end-of-life (EOL) care by
race/ethnicity, but few studies have examined physicians' values, beliefs and concerns
regarding EOL decision-making for their patients. We explored how physicians help
patients and surrogates make EOL decisions, and how physicians' race/ethnicity might
influence it. 7 focus groups (3 white, 2 black, 2 Hispanic) with internists or subspecialists
(n = 26) were conducted. Focus groups were structured by guiding questions, audiotaped
and transcribed. Investigators independently analyzed transcripts, assigned codes,
compared findings, reconciled differences, and developed thematic elements. Quotations
from transcripts illustrated final categories and themes. All physicians agreed that requests
for "doing everything" should be met by exploring what this meant to families, and to
explain potential harm of 'doing everything'. Most physicians felt uncomfortable
discussing EOL care due to lack of formal training though younger physicians felt
somewhat better prepared than older ones. Most physicians felt language barriers and level
of education were bigger barriers to effective communication, and that race or ethnicity of
the patient did not matter. However, both black and Hispanic physicians felt patients of
their own race/ethnicity might be more comfortable with a race-concordant physician due
to speaking the same language (Hispanics) or due to expressing faith and religiosity more
openly (African Americans), both elements that could increase trust in the physician.
Hispanic physicians stressed need for family support and involvement in the decision making
process, and reported conflicts regarding truth telling of bad diagnoses.