title: Focus group findings about the influence of culture on communication preferences in end-of-life care.
abstract: BACKGROUND
  Little guidance is available for health care providers who try to communicate with patients and their families in a culturally sensitive way about end-of-life care.
  
  
  OBJECTIVE
  To explore the content and structure of end-of-life discussions that would optimize decision making by conducting focus groups with two diverse groups of patients that vary in ethnicity and socioeconomic status.
  
  
  METHODS
  Six focus groups were conducted; 3 included non-Hispanic white patients recruited from a University hospital (non-Hispanic white groups) and 3 included African-American patients recruited from a municipal hospital (African-American groups). A hypothetical scenario of a dying relative was used to explore preferences for the content and structure of communication.
  
  
  METHODS
  Thirty-six non-Hispanic white participants and 34 African-American participants.
  
  
  METHODS
  Content analysis of focus group transcripts.
  
  
  RESULTS
  Non-Hispanic white participants were more exclusive when recommending family participants in end-of-life discussions while African-American participants preferred to include more family, friends and spiritual leaders. Requested content varied as non-Hispanic white participants desired more information about medical options and cost implications while African-American participants requested spiritually focused information. Underlying values also differed as non-Hispanic white participants expressed more concern with quality of life while African-American participants tended to value the protection of life at all costs.
  
  
  CONCLUSIONS
  The groups differed broadly in their preferences for both the content and structure of end-of-life discussions and on the values that influence those preferences. Further research is necessary to help practitioners engage in culturally sensitive end-of-life discussions with patients and their families by considering varying preferences for the goals of end-of-life care communication.
authors.affiliation: Division of General Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. William.Shrank@med.va.gov
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
authors.forename: Terri
authors.initials: T
authors.lastname: Richardson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mularski
authors.forename: Stacy
authors.initials: S
authors.lastname: Fischer
authors.forename: Marjorie
authors.initials: M
authors.lastname: Kagawa-Singer
mesh_terms: D016223:Advance Directives; D001741:Black or African American / Q000523:psychology*; D003142:Communication; D003469:Culture; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology*; D011788:Quality of Life; D012067:Religion; D012923:Social Class; D013727:Terminal Care; D014481:United States