Racial/Ethnic Preferences, Sex Preferences, and Perceived Discrimination Related to End-of-Life Care

Authors

  • Sonia A. Duffy PhD, RN,

    1. From the *Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, MichiganDepartments of Otolaryngology and Psychiatry, School of Nursing, University of Michigan, Ann Arbor, Michigan§School of Nursing, Oakland University, Rochester, MichiganCollege of Nursing, Wayne State University, Detroit, Michigan.
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  • Frances C. Jackson PhD, RN,

    1. From the *Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, MichiganDepartments of Otolaryngology and Psychiatry, School of Nursing, University of Michigan, Ann Arbor, Michigan§School of Nursing, Oakland University, Rochester, MichiganCollege of Nursing, Wayne State University, Detroit, Michigan.
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  • Stephanie M. Schim PhD, RN,

    1. From the *Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, MichiganDepartments of Otolaryngology and Psychiatry, School of Nursing, University of Michigan, Ann Arbor, Michigan§School of Nursing, Oakland University, Rochester, MichiganCollege of Nursing, Wayne State University, Detroit, Michigan.
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  • David L. Ronis PhD,

    1. From the *Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, MichiganDepartments of Otolaryngology and Psychiatry, School of Nursing, University of Michigan, Ann Arbor, Michigan§School of Nursing, Oakland University, Rochester, MichiganCollege of Nursing, Wayne State University, Detroit, Michigan.
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  • Karen E. Fowler MPH

    1. From the *Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, MichiganDepartments of Otolaryngology and Psychiatry, School of Nursing, University of Michigan, Ann Arbor, Michigan§School of Nursing, Oakland University, Rochester, MichiganCollege of Nursing, Wayne State University, Detroit, Michigan.
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  • This research was jointly funded by the Michigan Department of Community Health, Blue Cross/Blue Shield of Michigan (774.11), and the Department of Veterans Affairs. Data from this manuscript were presented to the Michigan Hospice and Palliative Care Organization, Kalamazoo Michigan, August 2004, and at the Eighth International Congress of Behavioral Medicine, Mainz, Germany, August 27, 2004.

Address correspondence to Sonia A. Duffy, PhD, RN, Ann Arbor Veterans Affairs Hospital (11H), Center for Practice Management and Outcomes Research, PO Box 130170, Ann Arbor, MI 48113. E-mail: Sonia.Duffy@med.va.gov

Abstract

This study investigated racial/ethnic preferences, sex preferences, and perceived discrimination related to end-of-life care. Ten focus groups and a follow-up survey were conducted to obtain in-depth information on end-of-life preferences across five racial/ethnic groups in Michigan stratified by sex. There were 73 focus group participants, including Arab Muslims, Arab Christians, Hispanics, blacks, and whites. The mean age±standard deviation was 67±8.5 (range 50–83). A focus group screener was used to recruit participants. A moderator discussion guide was used to guide the focus groups. A take-home questionnaire asked about demographic information and end-of-life issues.

Arab Americans were in favor of making peace on earth and were against assisted suicide, extending life artificially, nursing homes, and telling the patient “bad news.” Hispanic and black women were against assisted suicide and in favor of extending life, whereas the men in these groups felt the opposite. Hispanic women spoke of not wanting a feeding tube and would consider alternative medicine. Blacks were least opposed to nursing homes. For whites, it was important to have choices. When asked about discrimination related to end-of-life care, Muslim women spoke of cultural barriers, blacks spoke of inequities in the past, and whites spoke of age discrimination and abandonment when dying.

As the population becomes more diverse and continues to age, it will be important to provide culturally and sex-sensitive end-of-life interventions to increase patient/family satisfaction and allocate resources appropriately.

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