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Minority Populations and Advance Directives: Insights from a Focus Group Methodology

Published online by Cambridge University Press:  03 August 2009

Joshua M. Hauser ,
Sharon F. Kleefield ,
Troyen A. Brennan  and
Ruth L. Fischbach
Joshua M. Hauser
Affiliation:
A first-year resident in the Department of Medicine at the Brigham and Women's Hospital in Boston, Massachusetts. He was affiliated with the Harvard School of Public Health at the time of this study.
Sharon F. Kleefield
Affiliation:
Director of Quality Improvement in the Department of Quality Measurement and Improvement, Brigham and Women's Hospital, Boston, Massachusetts.
Troyen A. Brennan
Affiliation:
Professor of Law and Public Health at the Harvard School of Public Health, professor of medicine at Harvard Medical School, and Executive Directive of Brigham and Women's Hospital Physician Hospital Organization.
Ruth L. Fischbach
Affiliation:
Assistant professor of Social Medicine in the Department of Social Medicine at Harvard Medical School, with appointments in the Division of Medical Ethics and the Division on Aging.
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Extract

Numerous studies have shown almost uniformly positive opinions among patients and physicians regarding the concept of advance directives (either a healthcare proxy or living will). Several of these studies have also shown that the actual use of advance directives is significantly lower than this enthusiasm would suggest, but they have not explained the apparent discordance. Nor have researchers explained why members of minority groups are much less likely to complete advance directives than are white patients. In this study, we used a focus group methodology to examine the ways in which diverse populations of patients view the medical, philosophical, and practical issues surrounding advance directives. We were motivated by the significantly lower prevalence of advance directives among African-American and Hispanic patients at one urban teaching hospital (18% for Caucasians, 4% for African-Americans, and 2% for Hispanics). Our premise was that African-American and Hispanic populations, who have had higher rates of morbidity and mortality across numerous disease categories, and historically have had limited access to care and opportunities to discuss health concerns, may be more suspicious about the right of autonomy that an advance directive is designed to ensure.

Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 6 , Issue 1 , Winter 1997 , pp. 58 - 71
Copyright
Copyright © Cambridge University Press 1997

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References

Notes

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