title: Decision-making styles of seriously ill male Veterans for end-of-life care: Autonomists, Altruists, Authorizers, Absolute Trusters, and Avoiders.
abstract: OBJECTIVE
  To describe self-reported decision-making styles and associated pathways through end-of-life (EOL) decision-making for African-American, Caucasian, and Hispanic seriously ill male Veterans, and to examine potential relationships of race/ethnicity on these styles.
  
  
  METHODS
  Forty-four African American, White, and Hispanic male Veterans with advanced serious illnesses participated in 8 racially/ethnically homogenous focus groups. Transcripts were qualitatively analyzed to identify major themes, with particular attention to themes that might be unique to each of the racial/ethnic groups.
  
  
  RESULTS
  Patients described two main decision-making styles, deciding for oneself and letting others decide, leading to five variants that we labeled Autonomists, Altruists, Authorizers, Absolute Trusters, and Avoiders. These variants, with exception of avoiders (not found among White patients), were found across all racial/ethnic groups. The variants suggested different 'implementation strategies', i.e., how clear patients made decisions and whether or not they then effectively communicated them.
  
  
  CONCLUSIONS
  These identified decision-making styles and variants generate strategies for clinicians to better address individualized advance care planning.
  
  
  CONCLUSIONS
  Physicians should elicit seriously ill patients' decision-making styles and consider potential implementation strategies these styles may generate, thus tailoring individualized recommendations to assist patients in their advance care planning. Patient-centered EOL decision-making can ensure that patient preferences are upheld.
authors.affiliation: Health Services Research & Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, USA; Baylor College of Medicine, Department of Medicine, Section of Geriatrics, Houston, USA. Electronic address: ubraun@bcm.edu.
authors.forename: Ursula K
authors.initials: UK
authors.lastname: Braun
authors.affiliation: Geriatric Research Education Clinical Center, NF/SGVHS, Department of Medicine, University of Florida College of Medicine, Gainesville, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
authors.affiliation: Department of Biostatistics, Bioinformatics, and Epidemiology and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA.
authors.forename: Marvella E
authors.initials: ME
authors.lastname: Ford
authors.affiliation: Health Services Research & Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Espadas
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, USA.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives; D001741:Black or African American / Q000523:psychology; D000533:Altruism; D001293:Attitude to Death / Q000208:ethnology*; D003431:Cross-Cultural Comparison; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D026684:Personal Autonomy; D010551:Personality; D036301:Qualitative Research; D057566:Self Report; D013727:Terminal Care / Q000523:psychology*; D035502:Trust; D014728:Veterans / Q000523:psychology*; D044465:White People / Q000523:psychology
keywords: Decision-making; End-of-life care; Qualitative research; Race/ethnicity; Veterans