Hornung C A, Eleazer G P, Strothers H S, Wieland G D, Eng C, McCann R, Sapir M
University of South Carolina School of Medicine, Columbia, USA.
J Am Geriatr Soc. 1998 Mar;46(3):280-6. doi: 10.1111/j.1532-5415.1998.tb01038.x.
To assess the relationship between ethnicity and decision-makers expressing healthcare wishes in a group of frail older persons enrolled in the Program of All-inclusive Care for the Elderly (PACE).
A retrospective chart review of 1193 participants in the PACE program.
Program of All-inclusive Care for the Elderly, a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation.
A total of 1193 older adults, all of whom met state criteria for nursing home level of care. Three hundred were non-Hispanic whites, 364 were black, 156 were Hispanic, and 288 were Asian.
Demographic characteristics of the patients and the presence or absence of an alternative decision-maker; the characteristics of alternative decision-makers included the relationship to the participant as recorded in the patient's medical record.
Ninety-one percent of white patients expressed their own healthcare wishes in contrast to only 85% of Hispanic, 83% of Asian, and 67% of black patients. An alternative decision-maker was identified for about 15% of Asians and Hispanics and for one-third of blacks, but only about 8% of whites had an alternative decision-maker. Black and Hispanic patients were most likely to have a daughter as an alternative decision-maker, Asians were most likely to have a son, and whites patients were most likely to have a spouse as an alternative decision-maker. Blacks, particularly black men, were the most likely to have a relative other than a spouse or child as an alternative decision-maker.
In this population, we found significant ethnic variation in the person identified to be the decision-maker in a group of frail older people. Ethnic variation reflected sociodemographic as well as cultural differences. However, there are important limitations to this study, and caution should be used in extrapolating the results to other populations or in attributing the results to ethnicity alone. An awareness of cross-cultural patterns in identified or de facto decision-makers can be significant for healthcare workers when they approach patients and their families about issues surrounding end of life decisions.
评估种族与在一组参加老年全面护理计划（PACE）的体弱老年人中表达医疗保健意愿的决策者之间的关系。
对1193名PACE计划参与者进行回顾性病历审查。
老年全面护理计划，一项在全国10个地点为体弱老年参与者提供服务的综合性管理式护理示范项目。
总共1193名老年人，他们均符合养老院护理水平的州标准。其中300人为非西班牙裔白人，364人为黑人，156人为西班牙裔，288人为亚洲人。
患者的人口统计学特征以及是否存在替代决策者；替代决策者的特征包括患者病历中记录的与参与者的关系。
91%的白人患者表达了自己的医疗保健意愿，相比之下，只有85%的西班牙裔、83%的亚洲人和67%的黑人患者表达了自己的意愿。约15%的亚洲人和西班牙裔以及三分之一的黑人有替代决策者，但只有约8%的白人有替代决策者。黑人和西班牙裔患者最有可能让女儿作为替代决策者，亚洲人最有可能让儿子作为替代决策者，白人患者最有可能让配偶作为替代决策者。黑人，尤其是黑人男性，最有可能让配偶或孩子以外的亲属作为替代决策者。
在这一人群中，我们发现体弱老年人中确定的决策者存在显著的种族差异。种族差异反映了社会人口统计学以及文化差异。然而，本研究存在重要局限性，在将结果外推至其他人群或仅将结果归因于种族时应谨慎。当医护人员就临终决策相关问题与患者及其家属沟通时，了解已确定或实际存在的决策者的跨文化模式可能具有重要意义。
