• Ursula K Braun, Marvella E Ford, Rebecca J Beyth, and Laurence B McCullough.
• Houston VA Health Services Research & Development Center of Excellence, The Houston Center for Quality of Care & Utilization Studies, Department of Veteran Affairs, Michael E. DeBakey VA Medical Center, Houston, TX, USA. ubraun@bcm.edu
• Patient Educ Couns. 2010 Jul 1;80(1):3-9.

ObjectivePrevious studies have shown racial/ethnic differences in preferences for end-of-life (EOL) care. We aimed to describe values and beliefs guiding physicians' EOL decision-making and explore the relationship between physicians' race/ethnicity and their decision-making.MethodsSeven focus groups (3 Caucasian, 2 African American, 2 Hispanic) with internists and subspecialists (n=26) were conducted. Investigators independently analyzed transcripts, assigned codes, compared findings, reconciled differences, and developed themes.ResultsFour themes appeared to transcend physicians' race/ethnicity: (1) strong support for the physician's role; (2) responding to "unreasonable" requests; (3) organizational factors; and (4) physician training and comfort with discussing EOL care. Five themes physicians seemed to manage differently based on race/ethnicity: (1) preventing and reducing the burden of surrogate decision-making; (2) responding to requests for "doing everything;" (3) influence of physician-patient racial/ethnic concordance/discordance; (4) cultural differences concerning truth-telling; and (5) spirituality and religious beliefs.ConclusionsPhysicians in our multi-racial/ethnic sample emphasized their commitment to their professional role in EOL decision-making. Implicitly invoking the professional virtue of self-effacement, they were able to identify racially/ethnically common and diverse ethical challenges of EOL decision-making.Practice ImplicationsPhysicians should use professional virtues to tailor the EOL decision-making process in response to patients' race/ethnicity, based on patients' preferences.Published by Elsevier Ireland Ltd.

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