Rich Shayna E, Gruber-Baldini Ann L, Quinn Charlene C, Zimmerman Sheryl I
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Am Geriatr Soc. 2009 Jan;57(1):146-52. doi: 10.1111/j.1532-5415.2008.02090.x.
Studies have consistently shown racial disparities in advance directive completion for nursing home residents but have not examined whether this disparity is due to differences in interactions with healthcare providers. This study had two aims: to determine whether the racial disparity in advance directive completion by nursing home residents is related to differences in discussion of treatment restrictions with healthcare providers and to examine whether there is a racial disparity in perceptions of residents' significant others that additional discussions would be helpful. Participants were 2,171 white or black (16% of sample) residents newly admitted to 59 nursing homes. Data were collected from structured interviews with residents' significant others and review of nursing home charts. Questions included whether advance directives were completed, whether treatment restrictions were discussed with the resident or family, and whether more discussion would have been helpful. Frequencies according to race were determined for each question; P-values and logistic regression models were obtained. Black residents were less likely to have completed any advance directives (P<.001), and they (P<.001) and their family members (P<.001) were less likely than whites to have discussed treatment restrictions with healthcare providers. Logistic regression models indicated that disparity in treatment restrictions narrowed when these discussions occurred. Significant others of black residents were more likely than those of white residents to consider further discussion helpful (P<.001), especially with physicians. Racial disparity in treatment restrictions may be due in part to a difference in discussion with healthcare providers; increasing discussion may narrow this disparity.
研究一直表明，疗养院居民在预先指示完成情况方面存在种族差异，但尚未研究这种差异是否归因于与医疗服务提供者互动的差异。本研究有两个目的：确定疗养院居民在预先指示完成情况方面的种族差异是否与和医疗服务提供者讨论治疗限制的差异有关，并研究居民重要他人认为更多讨论会有帮助的看法中是否存在种族差异。参与者为新入住59家疗养院的2171名白人或黑人居民（占样本的16%）。数据通过对居民重要他人的结构化访谈以及疗养院病历审查收集。问题包括是否完成了预先指示、是否与居民或家属讨论了治疗限制，以及更多讨论是否会有帮助。针对每个问题确定了按种族划分的频率；获得了P值和逻辑回归模型。黑人居民完成任何预先指示的可能性较小（P<.001），而且他们（P<.001）及其家庭成员（P<.001）与医疗服务提供者讨论治疗限制的可能性低于白人。逻辑回归模型表明，当进行这些讨论时，治疗限制方面的差异会缩小。黑人居民的重要他人比白人居民的重要他人更有可能认为进一步讨论会有帮助（P<.001），尤其是与医生的讨论。治疗限制方面的种族差异可能部分归因于与医疗服务提供者讨论的差异；增加讨论可能会缩小这种差异。
