• William H Shrank, Jean S Kutner, Terri Richardson, Richard A Mularski, Stacy Fischer, and Marjorie Kagawa-Singer.
• Division of General Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. William.Shrank@med.va.gov
• J Gen Intern Med. 2005 Aug 1; 20 (8): 703709703-9.

BackgroundLittle guidance is available for health care providers who try to communicate with patients and their families in a culturally sensitive way about end-of-life care.ObjectiveTo explore the content and structure of end-of-life discussions that would optimize decision making by conducting focus groups with two diverse groups of patients that vary in ethnicity and socioeconomic status.DesignSix focus groups were conducted; 3 included non-Hispanic white patients recruited from a University hospital (non-Hispanic white groups) and 3 included African-American patients recruited from a municipal hospital (African-American groups). A hypothetical scenario of a dying relative was used to explore preferences for the content and structure of communication.ParticipantsThirty-six non-Hispanic white participants and 34 African-American participants.ApproachContent analysis of focus group transcripts.ResultsNon-Hispanic white participants were more exclusive when recommending family participants in end-of-life discussions while African-American participants preferred to include more family, friends and spiritual leaders. Requested content varied as non-Hispanic white participants desired more information about medical options and cost implications while African-American participants requested spiritually focused information. Underlying values also differed as non-Hispanic white participants expressed more concern with quality of life while African-American participants tended to value the protection of life at all costs.ConclusionsThe groups differed broadly in their preferences for both the content and structure of end-of-life discussions and on the values that influence those preferences. Further research is necessary to help practitioners engage in culturally sensitive end-of-life discussions with patients and their families by considering varying preferences for the goals of end-of-life care communication.

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