Ethnicity and attitudes toward patient autonomy.
Ethnicity and attitudes toward patient autonomy.
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DOI：
10.1001/jama.1995.03530100060035
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发表时间：
1995-09
期刊：
影响因子：
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通讯作者：
L. Blackhall;S. Murphy;Gelya Frank;V. Michel;S. Azen
中科院分区：
文献类型：
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作者：
L. Blackhall;S. Murphy;Gelya Frank;V. Michel;S. Azen
目的研究不同民族老年人对临终疾病诊断、预后信息披露和临终决策的态度差异。设计调查。背景：加州洛杉矶县内的31个老年人中心。一个分层的配额样本，200名年龄在65岁及以上的受试者，自认为来自四个种族：欧洲裔美国人，非洲裔美国人，韩裔美国人，或墨西哥裔美国人（N = 800）。主要观察指标和结果韩裔美国人（47%）和墨西哥裔美国人（65%）比欧洲裔美国人（87%）和非洲裔美国人（88%）更不可能相信患者应该被告知转移性癌症的诊断。与非洲裔美国人（63%）和欧洲裔美国人（69%）相比，韩裔美国人（35%）和墨西哥裔美国人（48%）不太可能相信患者应该被告知晚期预后，也不太可能相信患者应该决定使用生命支持技术（28%和41% vs 60%和65%）。相反，韩裔美国人和墨西哥裔美国人倾向于认为家庭应该决定使用生命支持。在逐步多元逻辑回归分析中，种族是与讲真话和患者决策态度相关的主要因素。结论：韩裔美国人和墨西哥裔美国人更倾向于以家庭为中心的医疗决策模式，而不是大多数非洲裔美国人和欧洲裔美国人受试者所青睐的患者自主模式。这一发现表明，医生应该问他们的病人，如果他们希望获得信息和作出决定，或者如果他们更喜欢他们的家人处理这些问题。
OBJECTIVE To study differences in the attitudes of elderly subjects from different ethnic groups toward disclosure of the diagnosis and prognosis of a terminal illness and toward end-of-life decision making. DESIGN Survey. SETTING Thirty-one senior citizen centers within Los Angeles County, California. RESPONDENTS A stratified quota sample of 200 subjects aged 65 years and older self-identified as being from each of four ethnic groups: European American, African American, Korean American, or Mexican American (N = 800). MAIN OUTCOME MEASURES AND RESULTS Korean Americans (47%) and Mexican Americans (65%) were significantly less likely than European Americans (87%) and African Americans (88%) to believe that a patient should be told the diagnosis of metastatic cancer. Korean Americans (35%) and Mexican Americans (48%) were less likely than African Americans (63%) and European Americans (69%) to believe that a patient should be told of a terminal prognosis and less likely to believe that the patient should make decisions about the use of life-supporting technology (28% and 41% vs 60% and 65%). Instead, Korean Americans and Mexican Americans tended to believe that the family should make decisions about the use of life support. On stepwise multiple logistic regression, ethnicity was the primary factor related to attitudes toward truth telling and patient decision making. CONCLUSIONS Korean-American and Mexican-American subjects were more likely to hold a family-centered model of medical decision making rather than the patient autonomy model favored by most of the African-American and European-American subjects. This finding suggests that physicians should ask their patients if they wish to receive information and make decisions or if they prefer that their families handle such matters.