Ethnicity No Predictor of End-of-Life Wishes

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Financial and communication barriers are major impediments to quality end-of-life care for ethnic minorities.

Ethnic minorities want to have conversations with their physicians about quality end-of-life care, but barriers, such as poor communications and financial problems, interfere with that desire, according to Stanford University School of Medicine researchers. Their study in the Journal of Palliative Medicine found that ethnicity does not predict the type of end-of-life care people want.

“There is so much generalization and stereotyping by physicians about how ethnic minorities want ‘everything’ done, irrespective of how effective these treatments might be at the end of life,” lead author VJ Periyakoil, MD, clinical associate professor of Medicine at Stanford, said in a statement. “In reality, it is more of a socioeconomic issue than an ethnic issue.”


The inequalities in healthcare that occur across ethnic and socioeconomic groups persist well into end-of-life care, the study found, with seriously ill patients in ethnic minorities disproportionately affected by poor-quality care.

The researchers interviewed 315 people of multiethnic background (117 white Americans, 38 African-Americans, and 160 Asian Americans) older than 50 years from cities across the San Francisco Bay Area. Medical interpreters accompanied researchers into community-based senior centers, where interviews were conducted in participants’ preferred languages (Spanish and 5 Asian languages).

A majority (61%) of patients said there were barriers to receiving high-quality care for members of their ethnic group. The biggest barriers were finances and health insurance followed by physician behavior, communication problems with doctors, family beliefs, health system barriers, and cultural/religious barriers. There were no significant differences in how the various ethnic groups ranked the barriers.

Education level was found to have a significant effect on responses. Participants with no formal education found financial issues to be most challenging, followed by communication problems with physicians. Communication problems included doctors being too busy to initiate conversations and doctors being either unaware of or insensitive to cultural/spiritual needs, causing patients to avoid the intensely personal end-of-life conversations. In addition, participants had problems understanding medical terminology. Participants with any other level of education identified doctor behaviors as being the biggest barrier.

The study authors noted that providing culturally competent end-of-life care is becoming more essential in the United States as the nation becomes one with a majority population made up of minorities by 2033, and the fragmented healthcare system does a poor job of training doctors to communicate effectively with their patients about end-of-life choices.