The Influence of Physician Race, Age, and Gender on Physician Attitudes Toward Advance Care Directives and Preferences for End-of-Life Decision-Making
Mebane, Eric W.
Oman, Roy F.
Kroonen, Leo T.
Goldstein, Mary K.
Journal of the American Geriatrics Society. 1999 May; 47(5): 579-591.
OBJECTIVE: To determine whether physicians' preferences for end-of-life decision-making differ between blacks and whites in the same pattern as patient preferences, with blacks being more likely than whites to prefer life-prolonging treatments. DESIGN: A mailed survey. SETTING AND PARTICIPANTS: American Medical Association (AMA) and National Medical Association (NMA) databases. To enrich the sample of black physicians, we targeted physicians in the AMA database practicing in high minority area zip codes and graduates of the traditionally black medical schools. MAIN OUTCOME MEASURES: Self-reported physician attitudes toward end-of-life decision-making and preference of treatment for themselves in persistent vegetative state or organic brain disease compared by race, controlling for age and gender. RESULTS: The 502 physicians (28%) who returned the questionnaire included 280 white and 157 black physicians. With regard to attitudes toward patient care, 58% of white physicians agreed that tube-feeding in terminally ill patients is "heroic," but only 28 % of black physicians agreed with the statement (P less than .001). White physicians were more likely than black physicians to find physician-assisted suicide an acceptable treatment alternative (36.6% vs 26.5% of black physicians) (P less than .05). With regard to the physicians preferences for future treatment of themselves for the persistent vegetative state scenario, black physicians were more than six times more likely than white physicians to request aggressive treatments (cardiopulmonary resuscitation, mechanical ventilation, or artificial feeding) for themselves (15.4% vs 2.5%) (P less than .001). White physicians were almost three times as likely to want physician-assisted suicide (29.3% vs 11.8%) (P less than .001) in this scenario. For a state of brain damage with no terminal illness, the majority of all physicians did not want aggressive treatment, but black physicians were nearly five times more likely than white physicians (23.0% vs 5.0%) (P less than .001) to request these treatments. White physicians, on the other hand, were more than twice as likely to request physician-assisted suicide (22.5% vs 9.9%), P less than .001 in this scenario. CONCLUSIONS: Physicians preferences for end-of-life treatment follow the same pattern by race as patient preferences, making it unlikely that low socioeconomic status or lack of familiarity with treatments account for the difference. Self-denoted race may be a surrogate marker for other, as yet undefined, factors. The full spectrum of treatment preferences should be considered in development of guidelines for end-of-life treatment in our diverse society.
Advance Care Planning; Advance Directives; Age Factors; Allowing to Die; Artificial Feeding; Assisted Suicide; Attitudes; Autonomy; Brain; Comparative Studies; Cultural Pluralism; Databases; Disease; Family Practice; Females; Guidelines; Internal Medicine; Illness; Life; Males; Medical Schools; Medicine; Patient Care; Patients; Persistent Vegetative State; Physicians; Professional Autonomy; Prolongation of Life; Quality of Life; Questionnaires; Resuscitation; Schools; Suffering; Suicide; Survey; Terminally Ill; Treatment Refusal; Value of Life; Ventilators; Withholding Treatment;
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The Influence of Physician Race, Age, and Gender on Physician Attitudes Toward Advance Care Directives and Preferences for End- of-Life Decision-Making Mebane, Eric W.; Oman, Roy F.; Kroonen, Leo T.; Goldstein, Mary K. (1999-05)