Racial and ethnic differences in preferences for end-of-life treatment.
BACKGROUND
Studies using local samples suggest that racial minorities anticipate a greater preference for life-sustaining treatment when faced with a terminal illness. These studies are limited by size, representation, and insufficient exploration of sociocultural covariables.


OBJECTIVE
To explore racial and ethnic differences in concerns and preferences for medical treatment at the end of life in a national sample, adjusting for sociocultural covariables.


METHODS
Dual-language (English/Spanish), mixed-mode (telephone/mail) survey.


METHODS
A total of 2,847 of 4,610 eligible community-dwelling Medicare beneficiaries age 65 or older on July 1, 2003 (62% response).


METHODS
Demographics, education, financial strain, health status, social networks, perceptions of health-care access, quality, and the effectiveness of mechanical ventilation (MV), and concerns and preferences for medical care in the event the respondent had a serious illness and less than 1 year to live.


RESULTS
Respondents included 85% non-Hispanic whites, 4.6% Hispanics, 6.3% blacks, and 4.2% "other" race/ethnicity. More blacks (18%) and Hispanics (15%) than whites (8%) want to die in the hospital; more blacks (28%) and Hispanics (21.2%) than whites (15%) want life-prolonging drugs that make them feel worse all the time; fewer blacks (49%) and Hispanics (57%) than whites (74%) want potentially life-shortening palliative drugs, and more blacks (24%, 36%) and Hispanics (22%, 29%) than whites (13%, 21%) want MV for life extension of 1 week or 1 month, respectively. In multivariable analyses, sociodemographic variables, preference for specialists, and an overly optimistic belief in the effectiveness of MV explained some of the greater preferences for life-sustaining drugs and mechanical ventilation among non-whites. Black race remained an independent predictor of concern about receiving too much treatment [adjusted OR = 2.0 (1.5-2.7)], preference for dying in a hospital [AOR = 2.3 (1.6-3.2)], receiving life-prolonging drugs [1.9 (1.4-2.6)], MV for 1 week [2.3 (1.6-3.3)] or 1 month's [2.1 (1.6-2.9)] life extension, and a preference not to take potentially life-shortening palliative drugs [0.4 (0.3-0.5)]. Hispanic ethnicity remained an independent predictor of preference for dying in the hospital [2.2 (1.3-4.0)] and against potentially life-shortening palliative drugs [0.5 (0.3-0.7)].


CONCLUSIONS
Greater preference for intensive treatment near the end of life among minority elders is not explained fully by confounding sociocultural variables. Still, most Medicare beneficiaries in all race/ethnic groups prefer not to die in the hospital, to receive life-prolonging drugs that make them feel worse all the time, or to receive MV.
Barnato
Amber E
AE
Center for Research on Health Care, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15312, USA. aeb2@pitt.edu
Anthony
Denise L
DL
Skinner
Jonathan
J
Gallagher
Patricia M
PM
Fisher
Elliott S
ES
D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death / Q000208:ethnology; D044383:Black People / Q000523:psychology; D003625:Data Collection / Q000379:methods; D005006:Ethnicity / Q000208:ethnology* / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D057240:Patient Preference / Q000208:ethnology*; D044469:Racial Groups / Q000208:ethnology* / Q000523:psychology*; D016414:Resuscitation Orders / Q000523:psychology; D013727:Terminal Care / Q000523:psychology*; D044465:White People / Q000523:psychology; D028761:Withholding Treatment