The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making
The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making
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DOI：
10.1111/j.1532-5415.1999.tb02573.x
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发表时间：
1999-05-01
影响因子：
6.3
通讯作者：
Goldstein, MK
中科院分区：
文献类型：
--
作者：
Mebane, EW;Oman, RF;Goldstein, MK
目的：为了确定医生对临终决策的偏好在黑人和白人之间是否存在与患者偏好相同的模式，黑人比白人更喜欢延长生命的治疗。设计：邮寄调查。为了丰富黑人医生的样本，我们针对AMA数据库中在少数民族地区邮政编码较高的地区执业的医生和传统黑人医学院的毕业生。主要观察指标：自我报告的医生对生命结束决策的态度和对持续植物人状态或器质性脑疾病治疗的偏好，通过种族进行比较，控制年龄和性别。返回问卷的502名医生（28%）包括280名白色医生和157名黑人医生。关于对病人护理的态度，58%的白色医生认为管饲晚期病人是“英雄”，但只有28%的黑人医生同意这一说法（P < .001）。与黑人医生相比，白色医生更倾向于认为医生协助自杀是一种可接受的治疗选择（36.6% vs 26.5%的黑人医生）（P < .05）。关于医生对持续性植物人状态的未来治疗的偏好，黑人医生要求积极治疗的可能性是白色医生的六倍多（心肺复苏、机械通气或人工喂养）（15.4%比2.5%）（P < .001）。在这种情况下，白色医生想要医生协助自杀的可能性几乎是白人医生的三倍（29.3%对11.8%）（P < .001）。对于没有绝症的脑损伤状态，大多数医生不希望进行积极的治疗，但黑人医生要求这些治疗的可能性是白色医生的近5倍（23.0%对5.0%）（P <0.001）。白色医生，另一方面，是两倍多的可能性，要求医生协助自杀（22.5%比9.9%），P <0.001，在这种scenarios.CONCLUSIONS：医生的喜好结束生命的治疗遵循相同的模式，由种族患者的喜好，使其不太可能，低社会经济地位或缺乏熟悉的治疗占的差异。自我表示的种族可能是其他尚未定义的因素的替代标记。在我们多元化的社会中，制定临终治疗指南时应考虑各种治疗偏好。
OBJECTIVE: To determine whether physicians' preferences for end-of-life decision-making differ between blacks and whites in the same pattern as patient preferences, with blacks being more likely than whites to prefer life-prolonging treatments.DESIGN: A mailed survey.SETTING AND PARTICIPANTS: American Medical Association (AMA) and National Medical Association (NMA) databases. To enrich the sample of black physicians, we targeted physicians in the AMA database practicing in high minority area zip codes and graduates of the traditionally black medical schools.MAIN OUTCOME MEASURES: Self-reported physician attitudes toward end-of-life decision-making and preference of treatment for themselves in persistent vegetative state or organic brain disease compared by race, controlling for age and gender.RESULTS: The 502 physicians (28%) who returned the questionnaire included 280 white and 157 black physicians. With regard to attitudes toward patient care, 58% of white physicians agreed that tube-feeding in terminally ill patients is "heroic," but only 28 % of black physicians agreed with the statement (P < .001). White physicians were more likely than black physicians to find physician-assisted suicide an acceptable treatment alternative (36.6% vs 26.5% of black physicians) (P < .05).With regard to the physicians preferences for future treatment of themselves for the persistent vegetative state scenario, black physicians were more than six times more likely than white physicians to request aggressive treatments (cardiopulmonary resuscitation, mechanical ventilation, or artificial feeding) for themselves (15.4% vs 2.5%) (P < .001). White physicians were almost three times as likely to want physician-assisted suicide (29.3% vs 11.8%) (P < .001) in this scenario. For a state of brain damage with no terminal illness, the majority of all physicians did not want aggressive treatment, but black physicians were nearly five times more likely than white physicians (23.0% vs 5.0%) (P < .001) to request these treatments. White physicians, on the other hand, were more than twice as likely to request physician-assisted suicide (22.5% vs 9.9%), P < .001 in this scenario.CONCLUSIONS: Physicians preferences for end-of-life treatment follow the same pattern by race as patient preferences, making it unlikely that low socioeconomic status or lack of familiarity with treatments account for the difference. Self-denoted race may be a surrogate marker for other, as yet undefined, factors. The full spectrum of treatment preferences should be considered in development of guidelines for end-of-life treatment in our diverse society.