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J Community Health Nurs. 2000 Spring;17(1):25-37.

End-of-life care directives among African Americans: lessons learned--a need for community-centered discussion and education.

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  • 1Department of Community Health Systems, School of Nursing, University of California, San Francisco 94143-0608, USA.


African Americans appear to be less likely to know about advance directives and, even if known, to complete them. This small, exploratory study used a community-centered educational group discussion to assess African Americans' knowledge, attitudes, and utilization of end-of-life care directives before the occurrence of a health crisis. McNemar and paired t tests were computed to detect immediate changes in participants' initial and final perceptions about advance directives before and after the group discussion. Findings indicated further education is needed to clarify the terms used for advance directives. African Americans rely on a family-centered approach to end-of-life decision making, especially in the absence of written advance directives. They are open to community forums to discuss end-of-life care choices if presented the opportunity. Culture plays an essential role in this issue. There is a need for community health nurses to develop community-based educational programs that are not a "one-size-fits-all" approach.

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