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Cultural Diversity at the End of Life: Issues and Guidelines for Family Physicians

Cultural Diversity at the End of Life: Issues and Guidelines for Family Physicians,H. RUSSELL SEARIGHT,JENNIFER GAFFORD

Cultural Diversity at the End of Life: Issues and Guidelines for Family Physicians   (Citations: 40)
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Ethnic minorities currently compose approximately one third of the population of the United States. The U.S. model of health care, which values autonomy in medical decision making, is not easily applied to members of some racial or ethnic groups. Cultural factors strongly influence patients' reactions to serious illness and decisions about end-of-life care. Research has identified three basic dimensions in end-of-life treatment that vary culturally: communication of "bad news"; locus of decision making; and attitudes toward advance directives and end-of-life care. In contrast to the emphasis on "truth telling" in the United States, it is not uncommon for health care professionals outside the United States to conceal serious diagnoses from patients, because disclosure of serious illness may be viewed as disrespectful, impolite, or even harmful to the patient. Similarly, with regard to decision making, the U.S. emphasis on patient autonomy may contrast with preferences for more family-based, physician-based, or shared physician- and family-based decision making among some cultures. Finally, survey data suggest lower rates of advance directive completion among patients of specific ethnic backgrounds, which may reflect distrust of the U.S. health care system, current health care disparities, cultural perspectives on death and suffering, and family dynamics. By paying attention to the patient's values, spirituality, and relationship dynamics, the family physician can elicit and follow cultural preferences. (Am Fam Physician 2005;71:515-22. Copyright© 2005 American Academy of Family Physicians.) Ethnic minorities compose an increasingly large proportion of the population of the United States. In the 2000 census, about 65 percent of the U.S. population identified themselves as white, with the remaining percentage representing the following ethnic groups: black (13 percent); Hispanic (13 percent); Asian-Pacific Islander (4.5 percent); and American-Indian/Alaskan native (1.5 percent). About 2.5 percent of the population identify themselves as bi-ethnic, and this figure is likely to continue to grow.1
Published in 2008.
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