Attitudes toward life-sustaining interventions among ambulatory black and white patients.

OBJECTIVES The purpose of this study was to evaluate racial differences in preference for life-sustaining interventions in the context of various physical and mental health scenarios. DESIGN Data were collected by using an investigator-administered survey. SETTING AND PATIENTS Consecutive patients who self-identified as African American or Caucasian were recruited from two private primary care practices in Rochester, New York. MAIN OUTCOME MEASURES Patients were asked to decide whether they would accept or decline life-sustaining intervention in eight scenarios, each involving a different combination of mental and physical disability. Information on religiousness, family integration, and experience with creating a healthcare proxy was also collected, as these variables were believed to be potential confounders of the relationship between race and preference. RESULTS Data from 77 patients (50 Black patients and 27 White patients) were analyzed. In multivariate log linear modeling, race was a significant predictor of preference for life-sustaining therapy, even after controlling for degree of mental and physical disability. Religiousness, family integration, and experience with creating a healthcare proxy did not explain racial differences in preference for life-sustaining therapy. CONCLUSIONS We have shown that ambulatory Black patients aged > or = 50 years are more likely than White patients to prefer life-sustaining care, and that these preferences persist across a wide range of mental and physical disabilities. This attitude conflicts with the prevailing ethic regarding end-of-life care, and Black patients and their families may consequently find have difficulty obtaining medical care that is consistent with their cultural values and beliefs. Policy decisions regarding end-of-life care must reflect a culturally diverse perspective.