Abstract:
OBJECTIVE:African-American (black) and white individuals have been shown to differ in their desire for life-sustaining treatments and their use of living wills for end-of-life care, but the reasons for these differences are unclear. This study was designed to test the hypothesis that these ethnic differences exist because black patients trust the health care system less, fear inadequate medical treatment more, and feel less confident that living wills can give them more control over their terminal care. DESIGN:Cross-sectional, in-person survey conducted from November 1993 to June 1994. SETTING:Two medical oncology clinics with 40% to 50% black patient representation. PARTICIPANTS:Ambulatory cancer patients, 92 black and 114 white, who were awaiting their physician visits and agreed to participate (76% of those eligible). Patients were excluded if they were under age 40 or if they had nonmelanoma skin cancer only. MEASUREMENTS AND MAIN RESULTS:Black ambulatory cancer patients wanted more life-sustaining treatments (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.4-5.3), and were less likely to want to complete a living will at some time in the future (OR 0.36; 95% CI 0.17-0.75) than were white patients after controlling for socioeconomic variables. However, these differences were not related to lack of trust or fear of inadequate medical treatment in this study population. Both groups of patients trusted the health care system and felt that physicians treated patients equally well. Neither group feared inadequate or excessive medical care, and the majority of both groups agreed that living wills would help them keep control over their terminal care. CONCLUSIONS:Black and white cancer patients make different end-of-life choices, even after adjusting for likely explanatory variables. The other factors that influence decision making remain unclear and need to be further explored if physicians are to understand and help their patients make choices for end-of-life care.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
McKinley ED,Garrett JM,Evans AT,Danis Mdoi
10.1007/BF02600155subject
Has Abstractpub_date
1996-11-01 00:00:00pages
651-6issue
11eissn
0884-8734issn
1525-1497journal_volume
11pub_type
杂志文章abstract:BACKGROUND:The transfer of critically ill patients from the intensive care unit (ICU) to hospital ward is challenging. Shortcomings in the delivery of care for patients transferred from the ICU have been associated with higher healthcare costs and poor satisfaction with care. Little is known about how hospital ward pro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
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更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To determine the impact of prospective payment by diagnosis-related groups (DRGs) on length of stay in the hospital, ambulatory status, and level of post-hospital care needed for patients hospitalized with hip fracture. DESIGN:Retrospective chart review of a consecutive series of cases before and after the r...
journal_title:Journal of general internal medicine
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journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章
doi:10.1046/j.1525-1497.2003.20410.x
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence. DESIGN:Prospective, counterbalanced experimental design. SETTING:Laboratory study co...
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更新日期:2005-04-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:1993-01-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2012-09-01 00:00:00
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更新日期:2007-11-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2008-03-01 00:00:00
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更新日期:1993-05-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2000-04-01 00:00:00
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更新日期:2010-10-01 00:00:00