Ethnic Differences in Advance Directive Completion and Care Preferences: What Has Changed in a Decade?
Ethnic Differences in Advance Directive Completion and Care Preferences: What Has Changed in a Decade?
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DOI：
10.1111/jgs.14800
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发表时间：
2017-06-01
影响因子：
6.3
通讯作者：
Enguidanos, Susan
中科院分区：
文献类型：
--
作者：
Portanova, Jaclyn;Ailshire, Jennifer;Enguidanos, Susan
研究表明，在完成预先指示（AD）方面存在种族差异，少数群体的比例较低。在患有AD的人中，黑人比白人更喜欢积极的护理，但很少有人知道这些偏好的差异如何随着时间的推移在种族群体中发生变化。这项具有全国代表性的研究旨在调查在调整重要的混杂变量后，AD发展的这些差异是否持续存在。对死亡年份进行了分析，以了解不同种族人群中AD完成情况如何随时间变化，对于AD患者，研究了这些因素与选择积极治疗之间的关联。使用了2000年至2012年健康与退休研究（HRS）对7，177名死者的离职访谈数据。分析包括逻辑回归，以确定种族和AD完成之间的关系和积极护理的偏好，以及它如何随着时间的推移在种族群体中变化。46%的死者完成了AD（白人51.7%，西班牙裔18.0%，黑人15.0%）。在完成AD的黑人中，23.8%的人选择了长期护理，而西班牙裔和白人的比例分别为13.3%和3.3%。Logistic回归显示，黑人完成AD的几率低75%，西班牙裔低70%。模型协变量对种族差异的影响很小，尽管在检查AD完成率随时间的变化时，黑人和白人的AD几率随着随后的死亡年份而增加，但西班牙裔则没有。需要进行更多的研究来调查文化差异对少数民族AD完成率的影响，以确保在临床环境中尊重偏好。
Studies have documented ethnic differences in advance directive (AD) completion, with lower rates in minority groups. Of those with ADs, blacks are more likely than whites to prefer aggressive care, but little is known about how these differences in preferences have changed over time in ethnic groups. This nationally representative study aimed to investigate whether these differences in AD development persisted after adjusting for important confounding variables. Year of death was analyzed to see how AD completion changed over time within ethnic groups, and for those with an AD, the association between these factors and opting for aggressive care was investigated. Data from the 2000 to 2012 Health and Retirement Study (HRS) exit interviews from 7,177 decedents were used. Analyses included logistic regression to determine the relationship between ethnicity and AD completion and preferences for aggressive care and how it changed over time in ethnic groups. Forty-six percent of decedents had completed an AD (whites 51.7%, Hispanics 18.0%, blacks 15.0%). Of blacks completing an AD, 23.8% elected prolonged care, compared with 13.3% of Hispanics and 3.3% of whites. Logistic regression revealed that blacks 75% lower odds of completing an AD and Hispanics had 70% lower odds. Model covariates had a small influence on ethnic differences, although in examining the change in AD completion over time, the odds of having an AD increased with each subsequent death year for blacks and whites but not Hispanics. Additional research is needed to investigate the effect of cultural differences in AD completion rates of ethnic minority groups to ensure that preferences are honored in the clinical setting.