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J Gen Intern Med. 2007 Nov;22(11):1579-82. Epub 2007 Sep 19.

Differences in the quality of the patient-physician relationship among terminally ill African-American and white patients: impact on advance care planning and treatment preferences.

Author information

1
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Brookline, MA, USA. asmith7@bidmc.harvard.edu

Abstract

BACKGROUND:

Little is known about the quality of the patient-physician relationship for terminally ill African Americans.

OBJECTIVE:

To compare the quality of the patient-physician relationship between African-American and white patients and examine the extent to which relationship quality contributes to differences in advance care planning (ACP) and preferences for intensive life-sustaining treatment (LST).

DESIGN:

Cross sectional survey of 803 terminally ill African-American and white patients.

MEASUREMENTS:

Patient-reported quality of the patient-physician relationship (degree of trust, perceived respect, and joint decision making; skill in breaking bad news and listening; help in navigating the medical system), ACP, preferences for LST (cardiopulmonary resuscitation, major surgery, mechanical ventilation, and dialysis).

RESULTS:

The quality of the patient-physician relationship was worse for African Americans than for white patients by all measures except trust. African Americans were less likely to have an ACP (adjusted relative risk [aRR] = 0.66, 95%CI = 0.52-0.84), and were more likely to have a preference for cardiopulmonary resuscitation and dialysis (aRR = 1.28, 95%CI = 1.03-1.58; aRR = 1.25, 95%CI = 1.07-1.47, respectively). Additional adjustment for the quality of the patient-physician relationship had no impact on the differences in ACP and treatment preferences.

CONCLUSIONS:

Lower reported patient-physician relationship quality for African-American patients does not explain the observed differences between African Americans and whites in ACP and preferences for LST.

PMID:
17879120
PMCID:
PMC2219809
DOI:
10.1007/s11606-007-0370-6
[Indexed for MEDLINE]
Free PMC Article
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