California State University, Long Beach
April 30, 2012
What Explains Racial Differences In The Use Of Advance Directives And Attitudes Toward Hospice Care?
Johnson, K.S., Kuchibhatla, M.,& Tulsky, A., (2008) What Explains Racial Differences In The
Use of Advance Directives and Attitudes Toward Hospice Care? Journal of Geriatric Society, Volume 56, Issue 10, 1953-1958
Hospice is a program developed to allow people who are terminally ill an opportunity to die with dignity. Many people choose to spend their final days at home with close friends and families members. Patients also receive this service in hospitals, nursing homes and in assisted living facilities. Patients are frequently given medication to relieve pain so that they are comfortable during their last days of life. Nurses and volunteers work together to provide the best care for patients (Ashman and Zastrow 2010). “Their emphasis is on helping people use the time that is left, rather than trying to keep people alive as long as possible”( Ashman and Zastrow 2010 p.648).
This article addresses racial differences between African American and Whites in the use of advanced directives and attitudes towards hospice care. The goal of the study is to determine if the subject’s views regarding the use of advanced directives and hospice care are influences by cultural difference and values. The subjects in the study were African Americans and Whites, age 65 and greater, they were required to give their consent to participate and must to be able to complete a 10 minute interview by phone. Each person were asked a series of questions focusing on demographic characteristics, preferences for end-of-life care, beliefs about dying and advance care planning, trust in the healthcare system, spirituality and hospice beliefs and attitudes. The results of the research revealed a significant difference between African Americans and Whites. African American older adults were less likely to prepare advanced directives (living will or power of attorney) if they were to become incapacitated and need someone to make decisions for them. They were more likely to rely on life-sustaining therapies (life support, tube feedings, dialysis), if they were to become terminally ill. African Americans were not comfortable discussing death, they had a lack of trust in the healthcare system and preferred spiritual beliefs over hospice care. Whereas White older adults were four times more likely to have an advance directive prepared and were had more favorable attitudes toward hospice care than African Americans. “None of these factors alone explained racial differences in either possession of advance directives or attitudes toward hospice, rather these differences were explained by a combination of beliefs and values”(Johnson, Kuchibhatla, Tulsy 2008).
Stress and Coping Theory Stress and coping theory applies to this article because this study requires the participants to think about potentially becoming terminally ill and make choices regarding death and dying. Death and dying is an ultimate stressor, although we all have to face death one day, it’s a topic that most people try to avoid discussing. The results of the article revealed that a large percentage of the older adults who were contacted by mail and by phone chose not participate in the study. This is an indication that people are not willing to explore options concerning advance directives and hospice care because it is a touchy and stressful topic. African American participants cope with death and dying through their spiritual beliefs as opposed to hospice care. They believe if you have faith in God you do not have to plan for end of life care. Whites cope with death and dying by preparing advance directives and are likely to accept hospice care.
Bio-Psycho-Social and Cultural Variables The articles biological aspects included African American and White