• Ursula K Braun, Rebecca J Beyth, Marvella E Ford, Donna Espadas, and Laurence B McCullough.
• Health Services Research & Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, USA; Baylor College of Medicine, Department of Medicine, Section of Geriatrics, Houston, USA. Electronic address: ubraun@bcm.edu.
• Patient Educ Couns. 2014 Mar 1;94(3):334-41.

ObjectiveTo describe self-reported decision-making styles and associated pathways through end-of-life (EOL) decision-making for African-American, Caucasian, and Hispanic seriously ill male Veterans, and to examine potential relationships of race/ethnicity on these styles.MethodsForty-four African American, White, and Hispanic male Veterans with advanced serious illnesses participated in 8 racially/ethnically homogenous focus groups. Transcripts were qualitatively analyzed to identify major themes, with particular attention to themes that might be unique to each of the racial/ethnic groups.ResultsPatients described two main decision-making styles, deciding for oneself and letting others decide, leading to five variants that we labeled Autonomists, Altruists, Authorizers, Absolute Trusters, and Avoiders. These variants, with exception of avoiders (not found among White patients), were found across all racial/ethnic groups. The variants suggested different 'implementation strategies', i.e., how clear patients made decisions and whether or not they then effectively communicated them.ConclusionThese identified decision-making styles and variants generate strategies for clinicians to better address individualized advance care planning.Practice ImplicationsPhysicians should elicit seriously ill patients' decision-making styles and consider potential implementation strategies these styles may generate, thus tailoring individualized recommendations to assist patients in their advance care planning. Patient-centered EOL decision-making can ensure that patient preferences are upheld.Published by Elsevier Ireland Ltd.

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