The physician's professional role in end-of-life decision-making: voices of racially and ethnically diverse physicians.
OBJECTIVE
Previous studies have shown racial/ethnic differences in preferences for end-of-life (EOL) care. We aimed to describe values and beliefs guiding physicians' EOL decision-making and explore the relationship between physicians' race/ethnicity and their decision-making.


METHODS
Seven focus groups (3 Caucasian, 2 African American, 2 Hispanic) with internists and subspecialists (n=26) were conducted. Investigators independently analyzed transcripts, assigned codes, compared findings, reconciled differences, and developed themes.


RESULTS
Four themes appeared to transcend physicians' race/ethnicity: (1) strong support for the physician's role; (2) responding to "unreasonable" requests; (3) organizational factors; and (4) physician training and comfort with discussing EOL care. Five themes physicians seemed to manage differently based on race/ethnicity: (1) preventing and reducing the burden of surrogate decision-making; (2) responding to requests for "doing everything;" (3) influence of physician-patient racial/ethnic concordance/discordance; (4) cultural differences concerning truth-telling; and (5) spirituality and religious beliefs.


CONCLUSIONS
Physicians in our multi-racial/ethnic sample emphasized their commitment to their professional role in EOL decision-making. Implicitly invoking the professional virtue of self-effacement, they were able to identify racially/ethnically common and diverse ethical challenges of EOL decision-making.


CONCLUSIONS
Physicians should use professional virtues to tailor the EOL decision-making process in response to patients' race/ethnicity, based on patients' preferences.
Braun
Ursula K
UK
Houston VA Health Services Research & Development Center of Excellence, The Houston Center for Quality of Care & Utilization Studies, Department of Veteran Affairs, Michael E. DeBakey VA Medical Center, Houston, TX, USA. ubraun@bcm.edu
Ford
Marvella E
ME
Beyth
Rebecca J
RJ
McCullough
Laurence B
LB
D000328:Adult; D032722:Advance Care Planning; D001741:Black or African American / Q000523:psychology; D001293:Attitude to Death / Q000208:ethnology*; D018864:Cultural Diversity; D003657:Decision Making / Q000941:ethics*; D005006:Ethnicity; D005260:Female; D017144:Focus Groups; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D024382:Professional Role / Q000523:psychology*; D036301:Qualitative Research; D013727:Terminal Care; D044465:White People / Q000523:psychology