Racial variations in end-of-life care.
OBJECTIVE
To identify differences in advanced care planning and end-of-life decision-making between whites and blacks aged 70 and older.


METHODS
The Asset and Health Dynamics Among the Oldest Old (AHEAD) study is a nationally representative survey of adults who were aged 70 and older in 1993. Relatives (proxy respondents) for 540 persons who died between the first (1993) and second (1995) waves of the study were surveyed about advanced care planning and end-of-life decisions that were made for their family member who died.


METHODS
Respondents were interviewed at home by telephone (n = 444) or in person (n = 95).


METHODS
The 540 proxy respondents included 454 whites and 86 blacks.


METHODS
Questions were asked about advance care planning and end-of-life decisions.


RESULTS
Whites were significantly more likely than blacks to discuss treatment preferences before death (P = .002), to complete a living will (P = .001), and to designate a Durable Power of Attorney for Health Care (DPAHC) (P = .032). The treatment decisions for whites were more likely to involve limiting care in certain situations (P = .007) and withholding treatment before death (P = .034). In contrast, the treatment decisions for blacks were more likely to be based on the desire to provide all care possible in order to prolong life (P = .013). Logistic regression models revealed that race continued to be a significant predictor of advance care planning and treatment decisions even after controlling for sociodemographic factors.


CONCLUSIONS
These findings suggest that there are important differences between blacks and whites regarding advanced care planning and end-of-life decision-making. Health professionals need to understand the diverse array of end-of-life preferences among various racial and ethnic groups and to develop greater awareness and sensitivity to these preferences when helping patients with end-of-life decision-making.
Hopp
F P
FP
Center For Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Michigan 48113-0170, USA.
Duffy
S A
SA
D032722:Advance Care Planning; D016223:Advance Directives; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003431:Cross-Cultural Comparison; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D010347:Patient Care Planning; D013727:Terminal Care; D014481:United States; D044465:White People / Q000523:psychology*