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Improving Palliative Care for Cancer
be treated differently and receive inferior care if advanced directives have been signed (McKinley et al., 1996). Blacks are also more likely to opt for aggressive treatment interventions even in a persistent vegetative state and generally tend to question the “humanitarian motives” of predominately white hospice workers (Neuberger and Hamilton, 1990). Based on results of a survey, it appears that African-American physicians place a higher value on length of life than do Caucasian physicians. This survey also revealed that African-American physicians are more likely to support cardiopulmonary resuscitation (CPR), mechanical ventilation, dialysis, and artificial feeding for themselves if they were in a persistent vegetative state (PVS) (McKinley et al., 1996; Mebane et al., 1999).
PHYSICIAN INFLUENCE ON END-OF-LIFE CARE
Physicians play a critical role in the lives of their terminally ill patients. Yet the majority of physicians were not trained in medical school or in continuing education courses about caring for patients at the end of life, communicating effectively and compassionately with them and their families, understanding the impact of cultural differences in addressing medical treatment at the end of life, or the importance of utilizing the full spectrum of medical support professionals in caring for these patients. There appear to be significant differences in attitudes between African-American and white physicians about care at the end of their patients’ lives and their own (Mebane et al., 1999). For example, white physicians more often view tube feedings as “heroic” measures in terminally ill patients than do African-American physicians (58 percent vs. 25 percent). In this same study, 36 percent of white physicians accept physician-assisted suicide (PAS) as a treatment alternative, while only 26.5 percent of African-American physicians do. When asked about care for themselves at the end of life, this study also observed startling differences between white and black physicians. For example, if in PVS, African-American physicians were six times more likely than whites to request aggressive treatment. In a scenario in which the doctors might be brain damaged but not terminally ill, the majority of both groups did not want aggressive treatment, but African-American physicians were five times more likely than whites to request specific aggressive treatment (23 percent vs 5 percent) and white physicians were two times more likely to request PAS than African Americans (22.5 percent vs. 9 percent).
Although African Americans constitute 13.8 percent of the U.S. population only 2.9 percent of the physician work force are African Americans; 30 percent of African Americans are cared for by African-American physicians (Byrd et al., 1994).