Differences in the quality of the patient-physician relationship among terminally ill African-American and white patients: Impact on advance care planning and treatment preferences
Differences in the quality of the patient-physician relationship among terminally ill African-American and white patients: Impact on advance care planning and treatment preferences
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DOI：
10.1007/s11606-007-0370-6
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发表时间：
2007-11-01
影响因子：
5.7
通讯作者：
Krakauer, Eric L.
中科院分区：
文献类型：
--
作者：
Smith, Alexander K.;Davis, Roger B.;Krakauer, Eric L.
背景：对非洲裔美国人晚期患者的医患关系质量知之甚少。目的：比较非裔美国人和白人患者的医患关系质量，并检验关系质量对提前护理计划(ACP)和强化生命维持治疗(LST)偏好的影响程度。设计：对803名非洲裔美国人和白人晚期患者进行横断面调查。测量：患者报告的医患关系质量(信任度、感知尊重和共同决策；突发坏消息和倾听的技能；帮助导航医疗系统)，ACP，对LST(心肺复苏，大手术，机械通气和透析)的偏好。结果：非裔美国人的医患关系质量在除信任之外的所有指标上都比白人患者差。非洲裔美国人患ACP的可能性较小(调整后的相对风险[ARR]=0.66，95%CI=0.52-0.84)，而更倾向于心肺复苏和透析(ARR=1.28，95%CI=1.03-1.58；ARR=1.25，95%CI=1.07-1.47)。对医患关系质量的额外调整对ACP和治疗偏好的差异没有影响。结论：非裔美国患者报告的较低的医患关系质量不能解释观察到的非裔美国人和白人在ACP和LST偏好上的差异。
BACKGROUND: Little is known about the quality of the patient-physician relationship for terminally ill African Americans.OBJECTIVE: To compare the quality of the patient-physician relationship between African-American and white patients and examine the extent to which relationship quality contributes to differences in advance care planning (ACP) and preferences for intensive life-sustaining treatment (LST).DESIGN: Cross sectional survey of 803 terminally ill African-American and white patients.MEASUREMENTS: Patient-reported quality of the patient-physician relationship (degree of trust, perceived respect, and joint decision making; skill in breaking bad news and listening; help in navigating the medical system), ACP, preferences for LST (cardiopulmonary resuscitation, major surgery, mechanical ventilation, and dialysis).RESULTS: The quality of the patient-physician relationship was worse for African Americans than for white patients by all measures except trust. African Americans were less likely to have an ACP (adjusted relative risk [aRR]=0.66, 95%CI=0.52-0.84), and were more likely to have a preference for cardiopulmonary resuscitation and dialysis (aRR=1.28, 95%CI=1.03-1.58; aRR=1.25, 95%CI=1.07-1.47, respectively). Additional adjustment for the quality of the patient-physician relationship had no impact on the differences in ACP and treatment preferences.CONCLUSIONS: Lower reported patient-physician relationship quality for African-American patients does not explain the observed differences between African Americans and whites in ACP and preferences for LST.