This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Phipps, E. Articles by Braitman, L. E. Search for Related Content PubMed PubMed Citation Articles by Phipps, E. Articles by Braitman, L. E. Social Bookmarking                            What's this?

Approaching the End of Life: Attitudes, Preferences, and Behaviors of African-American and White Patients and Their Family Caregivers

Etienne Phipps, Gala True, Diana Harris, Umi Chong, William Tester, Stephen I. Chavin, Leonard E. Braitman

From the Albert Einstein Healthcare Network, Philadelphia, PA.

Address reprint requests to Etienne Phipps, PhD, Albert Einstein Healthcare Network, Center for Urban Health Policy and Research, 1 Penn Blvd, Philadelphia, PA 19144; email: phippst{at}einstein.edu.

Purpose: To investigate differences in attitudes, preferences, and behaviors regarding end of life in terminally ill patients and their designated family caregivers.

Patients and Methods: 68 African-American and white patients with stage III-B or IV lung or stage IV colon cancer and 68 patient-designated family caregivers interviewed between December 1999 and May 2001.

Results: White patients were more likely to have a durable power of attorney (34% v 8%, P = .01) and were more likely to have a living will (LW; 41% v 11%, P = .004) than were African-American patients. More African-American than white patients desired the use of life-sustaining measures (cardiopulmonary resusitation [CPR], mechanical ventilation, tube feeding) in their current condition (all P > .12). In a near-death condition, African-American patients were more likely than white patients to desire each of the life-sustaining measures (all P < .004). There was no patient-caregiver agreement beyond chance regarding preferences for initiation of CPR, tube feeding, or mechanical ventilation in the patient’s current condition or in the near-death condition. In the near-death condition in patients without LWs, there was disagreement in 46% of patient-caregiver pairs about CPR, in 50% about mechanical ventilation, and in 43% about tube feeding.

Conclusion: Although most patients and families endorse the primacy of the patient in decisions at end of life, the majority do not take supporting actions. Disagreements between patients and families about the use of life-sustaining measures in patients without LWs may result in patients’ preferences being superseded at end of life.

Supported by grant R21 NR05112-02 from the National Institute of Nursing Research.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				E. Ko and J. Lee End-of-Life Communication: Ethnic Differences Between Korean American and Non-Hispanic White Older Adults J Aging Health, October 1, 2009; 21(7): 967 - 984. [Abstract] [PDF]

				A. Hanchate, A. C. Kronman, Y. Young-Xu, A. S. Ash, and E. Emanuel Racial and Ethnic Differences in End-of-Life Costs: Why Do Minorities Cost More Than Whites? Arch Intern Med, March 9, 2009; 169(5): 493 - 501. [Abstract] [Full Text] [PDF]

				A. G. Golden, M. H. Corvea, S. Dang, M. Llorente, and M. A. Silverman Assessing Advance Directives in the Homebound Elderly American Journal of Hospice and Palliative Medicine, February 1, 2009; 26(1): 13 - 17. [Abstract] [PDF]

				A. K. Smith, E. P. McCarthy, E. Paulk, T. A. Balboni, P. K. Maciejewski, S. D. Block, and H. G. Prigerson Racial and Ethnic Differences in Advance Care Planning Among Patients With Cancer: Impact of Terminal Illness Acknowledgment, Religiousness, and Treatment Preferences J. Clin. Oncol., September 1, 2008; 26(25): 4131 - 4137. [Abstract] [Full Text] [PDF]

				R. D. Boss, N. Hutton, L. J. Sulpar, A. M. West, and P. K. Donohue Values Parents Apply to Decision-Making Regarding Delivery Room Resuscitation for High-Risk Newborns Pediatrics, September 1, 2008; 122(3): 583 - 589. [Abstract] [Full Text] [PDF]

				K. Gerst and J. A. Burr Planning for End-of-Life Care: Black-White Differences in the Completion of Advance Directives Research on Aging, July 1, 2008; 30(4): 428 - 449. [Abstract] [PDF]

				Y. Htut, K. Shahrul, and P. Poi The Views of Older Malaysians on Advanced Directive and Advanced Care Planning: A Qualitative Study Asia Pac J Public Health, July 1, 2007; 19(3): 58 - 66. [Abstract] [PDF]

				J. Kwak and W. E. Haley Current Research Findings on End-of-Life Decision Making Among Racially or Ethnically Diverse Groups Gerontologist, October 1, 2005; 45(5): 634 - 641. [Abstract] [Full Text] [PDF]

				R. S. Morrison and D. E. Meier High Rates of Advance Care Planning in New York City's Elderly Population Arch Intern Med, December 13, 2004; 164(22): 2421 - 2426. [Abstract] [Full Text] [PDF]

				J. M. Sinclair, A. P. Ries, A. N. Galanos, E. J. Phipps, and L. E. Braitman Pharmaceutical cost trends: other factors. American Journal of Hospice and Palliative Medicine, November 1, 2004; 21(6): 417 - 418. [PDF]

				E. J. Phipps and L. E. Braitman Family caregiver satisfaction with care at end of life: Report from the cultural variations study (CVAS) American Journal of Hospice and Palliative Medicine, September 1, 2004; 21(5): 340 - 342. [Abstract] [PDF]

				G. M. Reisfield and G. R. Wilson Advance care planning redux: It's time to talk American Journal of Hospice and Palliative Medicine, January 1, 2004; 21(1): 7 - 9. [PDF]