Johnson Kimberly S, Elbert-Avila Katja I, Tulsky James A
Department of Medicine, Division of Geriatrics, Duke University Medical Center, DUMC Box 3003, Durham, NC 27710, USA.
J Am Geriatr Soc. 2005 Apr;53(4):711-9. doi: 10.1111/j.1532-5415.2005.53224.x.
Spirituality is an important part of African-American culture and is often cited as an explanation for the more-aggressive treatment preferences of some African Americans at the end of life. This paper reviews the literature on spiritual beliefs that may influence the treatment decisions of African Americans. Medline 1966 to February 2003, Psych Info 1872 to February 2003, and CINAHL 1982 to February 2003 were searched for studies exploring spiritual beliefs that may influence the treatment preferences of African Americans. All candidate papers were examined for quality, and data were extracted on study population, design, analysis, and results to identify recurrent themes. Forty studies met inclusion criteria. Recurrent themes describing spiritual beliefs that may influence the treatment preferences of African Americans throughout the course of illness include the following: spiritual beliefs and practices are a source of comfort, coping, and support and are the most effective way to influence healing; God is responsible for physical and spiritual health; and the doctor is God's instrument. Spiritual beliefs specifically addressing treatment preferences at the end of life include: only God has power to decide life and death, there are religious prohibitions against physician-assisted death or advance directives limiting life-sustaining treatments, and divine intervention and miracles occur. For some African Americans, spiritual beliefs are important in understanding and coping with illness and may provide a framework within which treatment decisions are made. Given the growing ethnic diversity of the United States, some understanding of the complexities of culture and spirituality is essential for healthcare providers.
灵性是非裔美国人文化的重要组成部分，常被引用来解释一些非裔美国人在生命末期更倾向于积极治疗的原因。本文回顾了可能影响非裔美国人治疗决策的灵性信仰相关文献。检索了1966年至2003年2月的Medline、1872年至2003年2月的Psych Info以及1982年至2003年2月的CINAHL，以查找探索可能影响非裔美国人治疗偏好的灵性信仰的研究。对所有候选论文进行质量审查，并提取有关研究人群、设计、分析和结果的数据，以确定反复出现的主题。40项研究符合纳入标准。描述在疾病过程中可能影响非裔美国人治疗偏好的灵性信仰的反复出现的主题包括：灵性信仰和实践是安慰、应对和支持的来源，是影响康复的最有效方式；上帝负责身心健康；医生是上帝的工具。专门针对生命末期治疗偏好的灵性信仰包括：只有上帝有权决定生死，存在反对医生协助死亡或限制维持生命治疗的预先指示的宗教禁令，以及神圣干预和奇迹会发生。对于一些非裔美国人来说，灵性信仰在理解和应对疾病方面很重要，可能为做出治疗决策提供一个框架。鉴于美国种族多样性的不断增加，医疗保健提供者对文化和灵性的复杂性有一定的了解至关重要。
