title: Factors That Impact End-of-Life Decision Making in African Americans With Advanced Cancer.
abstract: African Americans with cancer are less likely to use hospice services and more likely to die in the hospital than white patients with the same diagnosis. However, there is much that is not understood about the factors that lead African Americans to choose options for end-of-life care.
  
  
  
  A qualitative, descriptive design was used in this pilot study.
  
  
  
  Interviews were conducted with two groups of African Americans with advanced-stage cancer (people enrolled in hospice and those who were not under hospice care).
  
  
  
  End-of-life decisions were primarily guided by clinical factors, the patient-related physical, emotional, and cognitive symptoms that are sequelae of the underlying disease or medical treatments. The physician was the healthcare provider most likely to be involved in decision making with patients, family members, and caregivers. Individual factors, such as personal beliefs, influenced end-of-life decision making. Religion and spirituality were a topic in many interviews, but they did not consistently influence decision making.
  
  
  
  Future studies should include interviews with family members, caregivers, and healthcare professionals so that factors that impact end-of-life decision making can be fully described. Strategies to facilitate recruitment will need to be added to future protocols.
authors: Assistant Professor, University of Virginia, School of Nursing, Charlottesville.
authors: Cathy L
authors: CL
authors: Campbell
authors: Ishan C
authors: IC
authors: Williams
authors: Tamara
authors: T
authors: Orr
keywords: African Americans; decision making; hospice; qualitative research
references: Palliat Support Care. 2009 Jun;7(2):235-43
references: 19538807
references: JAMA. 1998 Jun 10;279(22):1801-7
references: 9628711
references: J Palliat Med. 2007 Apr;10(2):381-9
references: 17472510
references: J Palliat Med. 2006 Apr;9(2):451-63
references: 16629574
references: Cochrane Database Syst Rev. 2003;(2):CD001431
references: 12804407
references: Am J Hosp Palliat Care. 2003 Mar-Apr;20(2):121-8
references: 12693644
references: Oncol Nurs Forum. 2003 Nov-Dec;30(6):1022-8
references: 14603359
references: Gerontologist. 2002 Oct;42 Spec No 3:114-28
references: 12415142
references: Cancer Nurs. 2005 May-Jun;28(3):219-25
references: 15915067
references: Res Nurs Health. 2006 Jun;29(3):190-8
references: 16676340
references: J Nurs Scholarsh. 2009;41(4):420-8
references: 19941588
references: Cancer. 1984 May 1;53(9):2002-7
references: 6704925
references: Cancer. 2007 Jan 15;109(2 Suppl):414-24
references: 17173280
references: J Am Geriatr Soc. 2000 May;48(S1):S194-8
references: 10809475
references: Omega (Westport). 2004-2005;50(2):151-63
references: 16021737
references: Res Nurs Health. 1994 Aug;17(4):311-4
references: 8036279
references: JAMA. 2005 Jul 13;294(2):211-7
references: 16014595
references: Patient Educ Couns. 2006 Jun;61(3):397-404
references: 15970420
references: J Clin Ethics. 1993 Summer;4(2):155-65
references: 8334279
references: Oncol Nurs Forum. 2009 Jan;36(1):69-77
references: 19136340
references: Qual Health Res. 2004 Feb;14(2):204-25
references: 14768458
references: Cancer. 1980 Apr 15;45(8):2220-4
references: 7370963
references: Health Aff (Millwood). 2004 May-Jun;23(3):194-200
references: 15160817