title: Physician cultural sensitivity in African American advance care planning: a pilot study.
abstract: BACKGROUND
  Physician cultural sensitivity is particularly important for end-of-life care. This study correlates physicians' own racial background, clinical experience, and cultural sensitivity training with their attitudes, perceptions, and knowledge of advance care planning issues for African American patients.
  
  
  METHODS
  A cross-sectional self-report questionnaire was distributed to 236 physicians at three major teaching hospitals.
  
  
  RESULTS
  Seventy-eight percent of all surveys were returned (183/236). The respondent racial characteristics were 53% white, 28% Asian, and 17% black. While 72% of physicians agreed that different ethnic groups have distinct attitudes towards advance directives, 58% acknowledged lack of familiarity with end-of-life preferences of African American patients. Black physicians (African American and non-U.S.-born) rated the cultural sensitivity training they received on a 0-10 Likert-type scale as 5.43 (n=28) versus a 3.74 rating by white physicians (n=91; p=0.022). Black physicians (African American and non-U.S.-born, n=27) rated their familiarity with advance care planning preferences of African Americans as 5.89 and white physicians (n=90) rated theirs as 4.14 on a 10-point Likert-type scale (p=0.002). Finally, 88% of U.S.-born black physicians (7/8) versus 35% of white physicians (32/91) perceived that the Tuskegee experiment has impacted African American medical decision-making (p=0.014). Similarly, a greater proportion of African American physicians perceived that the Tuskegee experiment has impacted African American medical decision making, compared to non-U.S.-born black physicians (88% (7/8) versus 26% (5/19), p=0.008).
  
  
  CONCLUSIONS
  The majority of the physicians surveyed routinely provide end-of-life care and believe they are aware of racial differences in advance care planning. Yet, most were unfamiliar with specific end-of-life preferences of African American patients. We advocate for further research and cultural sensitivity training to improve end-of-life care for African American patients.
authors.affiliation: Department of Geriatrics, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA. mwallacemd@yahoo.com
authors.forename: Mervin P
authors.initials: MP
authors.lastname: Wallace
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Weiner
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.forename: Alicia
authors.initials: A
authors.lastname: Almendral
authors.forename: Reginald
authors.initials: R
authors.lastname: Cosiquien
authors.forename: Charles
authors.initials: C
authors.lastname: Auerbach
authors.forename: Gisele
authors.initials: G
authors.lastname: Wolf-Klein
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D001741:Black or African American; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010865:Pilot Projects; D013727:Terminal Care