Division of Health Care Policy and Research, University of Colorado Denver School of Medicine, Aurora, Colorado 80045-7201, USA.
J Palliat Med. 2012 Jan;15(1):86-92. doi: 10.1089/jpm.2011.0328. Epub 2012 Jan 12.
Previous studies have shown that minority populations have low rates of documented advance directives and express preferences for more life-prolonging interventions at the end of life. We sought to determine the impact of Latino ethnicity on patients' self-report of having an advance directive discussion and having a completed advance directive in the medical record at an index hospitalization for serious medical illness.
This was a prospective observational cohort study of 458 adults admitted to the general medical services of a safety net hospital, an academic medical center, and a Veterans' Affairs (VA) hospital. Patients were asked if they had discussed advance directives, and we reviewed medical records for documented advance directives.
Overall, 45% of patients reported having had a discussion about advance directives (29% of Latinos compared with 54% of Caucasians, p=0.0002) and 24% of patients had a completed advance directive in their medical record (25% Latinos and 26% of Caucasians, p=not significant [ns]). Using logistic regression modeling and adjusting for socioeconomic status (SES), education level, and language spoken, Latinos (odds ratio [OR] 0.42, confidence interval [CI] 0.24-0.75) were less likely to report having advance directive discussions compared with Caucasians (referent). However, modeling of a completed advance directive in the medical record showed no significant difference between Latinos (OR 1.44, CI 0.73-2.85) and Caucasians (referent).
The unexpected discrepancy we found highlights the need for more effective communication in advance care planning that includes education that is culturally sensitive and accessible to persons with low health literacy.
先前的研究表明，少数民族人群记录在案的预先指示和在生命末期表达对更多延长生命干预措施的偏好的比率较低。我们试图确定拉丁裔族群对患者在因严重疾病住院索引期间自我报告预先指示讨论和在病历中记录完成的预先指示的影响。
这是一项对 458 名入住一家保障网医院、一家学术医疗中心和一家退伍军人事务部 (VA) 医院的普通医疗服务的成年患者进行的前瞻性观察性队列研究。患者被询问是否讨论过预先指示，我们查阅病历以确定是否有记录在案的预先指示。
总体而言，45%的患者报告说他们已经讨论过预先指示（45%的拉丁裔患者，而 54%的白种人患者，p=0.0002），并且 24%的患者在病历中有完成的预先指示（25%的拉丁裔患者和 26%的白种人患者，p=无显著差异 [ns]）。使用逻辑回归模型并调整社会经济地位（SES）、教育水平和语言，与白种人（比值比 [OR] 0.42，置信区间 [CI] 0.24-0.75）相比，拉丁裔患者（OR 0.42，CI 0.24-0.75）报告说进行过预先指示讨论的可能性较小（参考）。然而，对病历中记录的完成的预先指示进行建模时，拉丁裔患者（OR 1.44，CI 0.73-2.85）和白种人（参考）之间没有显著差异。
我们发现的意外差异凸显了需要进行更有效的沟通，包括对文化敏感和易于理解的人进行预先护理计划教育，以提高文化敏感和健康素养较低的人的教育水平。
