ICU Docs Less Likely to Discuss End-of-Life Issues With Blacks

WEDNESDAY May 21, 2008 -- Intensive care unit (ICU) doctors are less comfortable discussing prognoses and end-of-life issues and do it less frequently with black patients and their families than with white patients and their families, say U.S. researchers.

They analyzed interviews with more than 1,200 ICU physicians caring for 9,105 seriously ill patients at five major medical centers. The interviews, conducted between 1989 and 1994, revealed that the doctors discussed prognoses with 58 percent of their white patients and 41 percent of their black patients. In addition, the ICU doctors were less than half (43 percent) as likely to report feeling comfortable during these conversations with their black patients.

One in five Americans will die in the ICU or shortly after a stay there. Frequently, these deaths occur after families make a decision to withdraw life support, according to the study authors.

"That is why it is so important that physicians are comfortable delivering difficult and sometimes complex diagnoses, potential outcomes and prognoses to patients and families in the ICU," researcher Dr. J. Daryl Thornton, of the Center for Reducing Health Disparities at MetroHealth Medical Center in Cleveland and Case Western Reserve University (CWRU), said in a prepared statement.

"Our study suggests there may be some underlying biases and/or discomfort among physicians, which impacts their ability to have these difficult conversations with families," said Thornton, an assistant professor at CWRU.

The study was expected to be presented Wednesday at the American Thoracic Society's International Conference, in Toronto.

"We had previously shown that ICU physicians, when predicting likelihood of survival of their patients, are less likely to predict that their African-American patients will survive," he said. "Ironically, those African-Americans were more likely to survive. These two studies, taken together, suggest we need to collect more information about what impacts the prognostic decisions by physicians, and whether any underlying biases are influencing the way they communicate with patients and families."

More information

The Society of Critical Care Medicine offers information for ICU patients and families.

Posted: May 2008


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