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What explains racial differences in the use of advance directives and attitudes toward hospice care?

Publication ,  Journal Article
Johnson, KS; Kuchibhatla, M; Tulsky, JA
Published in: J Am Geriatr Soc
October 2008

Cultural beliefs and values are thought to account for differences between African Americans and whites in the use of advance directives and beliefs about hospice care, but few data clarify which beliefs and values explain these differences. Two hundred five adults aged 65 and older who received primary care in the Duke University Health System were surveyed. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs About Dying and Advance Care Planning. African Americans were less likely than white subjects to have completed an advance directive (35.5% vs 67.4%, P<.001) and had less favorable beliefs about hospice care (Hospice Beliefs and Attitudes Scale score, P<.001). African Americans were more likely to express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs that conflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in possession of an advance directive or beliefs about hospice care, but when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. These findings suggest that ethnicity is a marker of common cultural beliefs and values that, in combination, influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs that provide culturally sensitive end-of-life care to a growing population of ethnically diverse older adults.

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Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

October 2008

Volume

56

Issue

10

Start / End Page

1953 / 1958

Location

United States

Related Subject Headings

  • White People
  • Terminal Care
  • Male
  • Humans
  • Hospice Care
  • Geriatrics
  • Female
  • Culture
  • Black or African American
  • Attitude to Death
 

Citation

APA
Chicago
ICMJE
MLA
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Johnson, K. S., Kuchibhatla, M., & Tulsky, J. A. (2008). What explains racial differences in the use of advance directives and attitudes toward hospice care? J Am Geriatr Soc, 56(10), 1953–1958. https://doi.org/10.1111/j.1532-5415.2008.01919.x
Johnson, Kimberly S., Maragatha Kuchibhatla, and James A. Tulsky. “What explains racial differences in the use of advance directives and attitudes toward hospice care?J Am Geriatr Soc 56, no. 10 (October 2008): 1953–58. https://doi.org/10.1111/j.1532-5415.2008.01919.x.
Johnson KS, Kuchibhatla M, Tulsky JA. What explains racial differences in the use of advance directives and attitudes toward hospice care? J Am Geriatr Soc. 2008 Oct;56(10):1953–8.
Johnson, Kimberly S., et al. “What explains racial differences in the use of advance directives and attitudes toward hospice care?J Am Geriatr Soc, vol. 56, no. 10, Oct. 2008, pp. 1953–58. Pubmed, doi:10.1111/j.1532-5415.2008.01919.x.
Johnson KS, Kuchibhatla M, Tulsky JA. What explains racial differences in the use of advance directives and attitudes toward hospice care? J Am Geriatr Soc. 2008 Oct;56(10):1953–1958.
Journal cover image

Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

October 2008

Volume

56

Issue

10

Start / End Page

1953 / 1958

Location

United States

Related Subject Headings

  • White People
  • Terminal Care
  • Male
  • Humans
  • Hospice Care
  • Geriatrics
  • Female
  • Culture
  • Black or African American
  • Attitude to Death