Abstract
BACKGROUND: Little guidance is available for health care providers who try to communicate with patients and their families in a culturally sensitive way about end-of-life care.
OBJECTIVE: To explore the content and structure of end-of-life discussions that would optimize decision making by conducting focus groups with two diverse groups of patients that vary in ethnicity and socioeconomic status.
DESIGN: Six focus groups were conducted; 3 included non-Hispanic white patients recruited from a University hospital (non-Hispanic white groups) and 3 included African-American patients recruited from a municipal hospital (African-American groups). A hypothetical scenario of a dying relative was used to explore preferences for the content and structure of communication.
PARTICIPANTS: Thirty-six non-Hispanic white participants and 34 African-American participants.
APPROACH: Content analysis of focus group transcripts.
RESULTS: Non-Hispanic white participants were more exclusive when recommending family participants in end-of-life discussions while African-American participants preferred to include more family, friends and spiritual leaders. Requested content varied as non-Hispanic white participants desired more information about medical options and cost implications while African-American participants requested spiritually focused information. Underlying values also differed as non-Hispanic white participants expressed more concern with quality of life while African-American participants tended to value the protection of life at all costs.
CONCLUSIONS: The groups differed broadly in their preferences for both the content and structure of end-of-life discussions and on the values that influence those preferences. Further research is necessary to help practitioners engage in culturally sensitive end-of-life discussions with patients and their families by considering varying preferences for the goals of end-of-life care communication.
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Funding for this project was provided by two sources: (1) A grant from the Division of General Internal Medicine at the University of Colorado Health Sciences Center and (2) A grant from the Institute of American Cultures at the University of California, Los Angeles.
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Shrank, W.H., Kutner, J.S., Richardson, T. et al. Focus group findings about the influence of culture on communication preferences in end-of-life care. J Gen Intern Med 20, 703–709 (2005). https://doi.org/10.1111/j.1525-1497.2005.0151.x
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DOI: https://doi.org/10.1111/j.1525-1497.2005.0151.x