Shrank WH (West LA Veterans Affairs Healthcare System, Division of General Internal Medicine)
Kutner JS (University of Colorado Health Sciences Center, Division of General Internal Medicine)
Richardson T (Kaiser Permanente, Denver)
Mularski RA (West LA Veterans Affairs Healthcare System)
Fischer S (University of Colorado Health Sciences Center, Division of Health Care Policy and Research)
Kagawa-Singer M (UCLA)
Little guidance is available for health care providers who aspire to communicate with patients and their families in a culturally sensitive way about end-of-life care. We explored 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 socio-economic status.
Six focus groups were conducted, three recruited from a University hospital (University groups) and three from a Municipal hospital (Municipal groups). A hypothetical scenario of a dying relative was used to explore preferences for the content and structure of optimal communication. 36 non-Hispanic white patients (University groups), and 34 African American participants (Municipal groups) participated. University group participants were more educated and had higher incomes than Municipal participants. Content analysis was used to analyze focus group transcripts.
University groups were more exclusive when recommending family participants and more concerned with the participation of specialists while Municipal groups emphasized the role of spiritual guidance in decision-making. The Municipal groups expressed more concerns about trust in the physician and health care system. The groups’ variant contextual beliefs about end-of-life care led them to use different heuristics when making decisions. University members desired more information about quality of life, medical options, and costs. Municipal members were more concerned with protecting life at all cost and requested spiritual assistance in decision-making. Both groups believed that advance directives are important and expressed a strong desire to follow the patient’s wishes for care.
The groups differed broadly in their preferences for the content and structure of end-of-life discussions.
Practitioners who want to engage in culturally-sensitive end-of-life discussions may improve communication by considering the varying informational needs and strategies used in end-of-life care decision-making identified in this study.