The physician's professional role in end-of-life decision-making: Voices of racially and ethnically diverse physicians

PATIENT EDUCATION AND COUNSELING

卷:80

Article

Braun, Ursula K.^1,2  Ford, Marvella E.³  Beyth, Rebecca J.⁴  McCullough, Laurence B.⁵ 

[1] Baylor Coll Med, Michael E DeBakey VA Med Ctr, Houston VA Hlth Serv Res & Dev Ctr Excellence, Houston Ctr Qual Care & Utilizat Studies,Dept Vet, Houston, TX 77030 USA

[2] Baylor Coll Med, Dept Med, Sect Geriatr, Houston, TX 77030 USA

[3] Med Univ S Carolina, Dept Biostat Bioinformat & Epidemiol, Charleston, SC 29425 USA

[4] Univ Florida, Dept Aging & Geriatr, COM, Gainesville, FL USA

[5] Baylor Coll Med, Ctr Med Eth & Hlth Policy, Houston, TX 77030 USA

关键词: End-of-life decision-making;    Physicians;    Race/ethnicity;   

DOI  :  10.1016/j.pec.2009.10.018

来源: Elsevier

【 摘 要 】

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. Practice implications: Physicians should use professional virtues to tailor the EOL decision-making process in response to patients' race/ethnicity, based on patients' preferences. Published by Elsevier Ireland Ltd.

【 授权许可】

Free