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How Honest Talk Helps Bridge Racial Divide in Senior Care Planning

Sarah Stevenson
By Sarah StevensonSeptember 17, 2012

Though studies show significant racial differences in senior health care choices, frank and respectful discussion can help more families see end-of-life care as a viable option for their loved ones.

One of the toughest discussions for caregivers and family members is deciding what to do for a loved one’s end-of-life care. Honest talk about topics like living wills, hospice care, and do-not-resuscitate (DNR) options can ultimately preserve seniors’ dignity and ensure that their health care wishes are respected. This is true even for racial or ethnic communities that have differing views on how to handle health care decisions.

5 Reasons for Racial Differences in End-of-Life Care

Conventionally, studies have shown differences in how racial groups view end-of-life care options. Among African Americans in particular, aggressive medical treatment is much more common than palliative care. Hospice enrollment is low in the black community compared to the population as a whole, and DNR orders are less frequent, despite the poor prognosis for many conditions such as late-stage cancer.

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The reasons for this are complex, but a handful of factors come to the forefront:

  • Many black families consider the end-of-life decision-making process as something to be agreed upon within the family or with a trusted friend such as a pastor.
  • Historical unfair treatment of minorities and poor patients has led to a mistrust of the health care system and the health insurance industry.
  • Even now, good health care can be more difficult to access for minority populations; underdiagnosis and substandard care are common issues.
  • High rates of Christian religious affiliation correlate with strong opinions about the morality of do-not-resuscitate orders.
  • Information about health care choices for seniors and the seriously ill does not always effectively reach African American consumers.

How Caregivers Can Help Loved Ones Plan for the Future

Though African Americans may have traditionally avoided end-of-life care, a recent study indicates that effective communication may be the key to changing people’s attitudes. Black patients and families who were given a palliative care consultation—in which information and treatment options were openly discussed in a caring and culturally sensitive manner—were far more likely to choose DNR orders and hospice care.

Caregivers play an important role in these critical decisions, too. Dr. Joseph Sacco of the Bronx-Lebanon Hospital Center, one of the authors of the study, said in a recent New York Times article that the difference lies in “providing patients and their families useful information in plain English, with compassion and clarity, enabling them to make choices in keeping with their desires and beliefs. Input from extended family, clergy members and parishioners was welcomed, and concern for disparity openly discussed.”

Though this method is currently the exception rather than the norm, Dr. Sacco is optimistic that an approach that is both informative and compassionate will help not only black families, but all caregivers and loved ones facing the same difficult decisions.

Have you discussed end-of-life treatment options with your senior loved ones? Have you felt that the current medical system has treated you and your family with dignity? We want to hear your experiences, good or bad.

Sarah Stevenson
Sarah Stevenson
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