Family Matters: Dyadic Agreement in End-of-Life Medical Decision Making

Autor/inn/en	Schmid, Bettina; Allen, Rebecca S.; Haley, Philip P.; DeCoster, Jamie
Titel	Family Matters: Dyadic Agreement in End-of-Life Medical Decision Making
Quelle	In: Gerontologist, 50 (2010) 2, S.226-237 (12 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0016-9013
DOI	10.1093/geront/gnp166
Schlagwörter	First Aid; Race; Research Methodology; Older Adults; Racial Differences; Cultural Differences; Cultural Context; Whites; Interpersonal Communication; Medical Evaluation; Comparative Analysis; Patients; African Americans; Raw Scores; Family (Sociological Unit); Terminal Illness; Health Needs; Decision Making; Medical Services + Suchen Sie Ihr Suchwort? Unfallhilfe; Rasse; Abstammung; Research method; Forschungsmethode; Älterer Erwachsener; Rassenunterschied; Kultureller Unterschied; White; Weißer; Interpersonale Kommunikation; Patient; Afroamerikaner; Familie; Decision-making; Entscheidungsfindung; Arzt
Abstract	Purpose: We examined race/ethnicity and cultural context within hypothetical end-of-life medical decision scenarios and its influence on patient-proxy agreement. Design and Methods: Family dyads consisting of an older adult and 1 family member, typically an adult child, responded to questions regarding the older adult's preferences for cardiopulmonary resuscitation, artificial feeding and fluids, and palliative care in hypothetical illness scenarios. The responses of 34 Caucasian dyads and 30 African American dyads were compared to determine the extent to which family members could accurately predict the treatment preferences of their older relative. Results: We found higher treatment preference agreement among African American dyads compared with Caucasian dyads when considering overall raw difference scores (i.e., overtreatment errors can compensate for undertreatment errors). Prior advance care planning moderated the effect such that lower levels of advance care planning predicted undertreatment errors among African American proxies and overtreatment errors among Caucasian proxies. In contrast, no racial/ethnic differences in treatment preference agreement were found within absolute difference scores (i.e., total error, regardless of the direction of error). Implications: This project is one of the first to examine the mediators and moderators of dyadic racial/cultural differences in treatment preference agreement for end-of-life care in hypothetical illness scenarios. Future studies should use mixed method approaches to explore underlying factors for racial differences in patient-proxy agreement as a basis for developing culturally sensitive interventions to reduce racial disparities in end-of-life care options. (As Provided).
Anmerkungen	Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://gerontologist.oxfordjournals.org
Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10