What explains racial differences in the use of advance directives and attitudes toward hospice care?
What explains racial differences in the use of advance directives and attitudes toward hospice care?
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DOI：
10.1111/j.1532-5415.2008.01919.x
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发表时间：
2008-10
影响因子：
6.3
通讯作者：
Tulsky, James A.
中科院分区：
文献类型：
--
作者：
Johnson, Kimberly S.;Kuchibhatla, Maragatha;Tulsky, James A.
人们认为，文化信仰和价值观是非裔美国人和白人在使用预先指示和临终关怀信仰方面存在差异的原因。然而，很少有数据能够阐明哪些信仰和价值观可以解释这些差异。我们调查了 205 名在杜克大学医疗系统接受初级保健的老年人（≥ 65 岁）。该调查包括五个量表：临终关怀信念和态度、护理偏好、灵性、医疗保健系统不信任以及对临终和预先护理计划的信念。与白人相比，非裔美国人完成预先医疗指示的可能性较小（35.5% vs. 67.4%，P<.001），并且对临终关怀的看法较差（临终关怀信念和态度量表得分，P<.001）。非裔美国人更有可能在讨论死亡时表达不舒服，希望在临终时得到积极的护理，有与姑息治疗目标相冲突的精神信仰，并且不信任医疗保健系统。在多变量分析中，这些因素都不能单独完全解释在拥有预先医疗指示或对临终关怀的信念方面的种族差异。然而，当所有这些因素结合起来时，种族不再是这两种结果的重要预测因素。我们的研究结果表明，种族是共同文化信仰和价值观的标志，它们共同影响临终时的决策。这项研究对医疗保健提供模式和计划的设计具有影响，这些模式和计划为不断增长的不同种族老年人口提供文化敏感的临终关怀。
Cultural beliefs and values are thought to account for differences between African Americans and Whites in the use of advance directives and beliefs about hospice care. However, little data clarifies which beliefs and values explain these differences. We surveyed 205 older adults (≥ age 65) who received primary care in the Duke University Health System. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs about Dying and Advance Care Planning. Compared to Whites, African Americans were less likely to have completed an advance directive (35.5% vs. 67.4%, P<.001) and had less favorable beliefs about hospice care (Hospice Beliefs and Attitudes Scale score, P<.001). African Americans were more likely to express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs which conflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in either possession of an advance directive or beliefs about hospice care. However, when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. Our findings suggest that ethnicity is a marker of common cultural beliefs and values which in combination influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs which provide culturally-sensitive end-of-life care to a growing population of ethnically diverse older adults.
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DOI：
10.1046/j.1365-2389.2003.51310.x
发表时间：
2003-07-01
影响因子：
6.3
作者：
Greiner, KA;Perera, S;Ahluwalia, JS
通讯作者：
Ahluwalia, JS
影响因子：
--
作者：
Morrison, RS;Meier, DE
通讯作者：
Meier, DE
影响因子：
5.7
作者：
Smith, Alexander K.;Davis, Roger B.;Krakauer, Eric L.
通讯作者：
Krakauer, Eric L.
影响因子：
2.8
作者：
Stahl, SM;Vasquez, L
通讯作者：
Vasquez, L
影响因子：
5.7
作者：
Rose, A;Peters, N;Armstrong, K
通讯作者：
Armstrong, K