title: Ethnicity, race, and advance directives in an inpatient palliative care consultation service.
abstract: OBJECTIVE
  Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).
  
  
  METHODS
  A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: "Do Not Resuscitate" (DNR) and/or "Do Not Intubate" (DNI).
  
  
  RESULTS
  Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.
  
  
  CONCLUSIONS
  This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.
authors.affiliation: North Shore-LIJ Health System, New Hyde Park, NY, USA.
authors.forename: Glenn B
authors.initials: GB
authors.lastname: Zaide
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.forename: Christian N
authors.initials: CN
authors.lastname: Nouryan
authors.forename: Tanveer P
authors.initials: TP
authors.lastname: Mir
authors.forename: Cristina P
authors.initials: CP
authors.lastname: Sison
authors.forename: Tara
authors.initials: T
authors.lastname: Liberman
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lesser
authors.forename: Lynda B
authors.initials: LB
authors.lastname: Cooper
authors.forename: Gisele P
authors.initials: GP
authors.lastname: Wolf-Klein
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000208:ethnology*; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D001293:Attitude to Death / Q000208:ethnology*; D003431:Cross-Cultural Comparison; D003657:Decision Making; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010166:Palliative Care / Q000458:organization & administration*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration*; D016414:Resuscitation Orders; D029181:Spirituality; D013727:Terminal Care / Q000458:organization & administration*; D044465:White People / Q000706:statistics & numerical data