Page 183 - Encyclopedia of Nursing Research

150 n END-OF-LiFE PLANNiNG AND CHOiCES

felt that the patient would have wanted tube that families are informed about what to
feeding. expect and have good communication with
E Ethnic, religious, and racial groups the physician, and patients have greater use
(considered homogeneously) differ with of hospice in comparison with patients with-
regard to EOL care and LST preferences and out an AD (Teno, Grunier, Schwartz, Nanda,
the context in, and process by which, such & Wetle, 2007).
decisions are made (Cox et al., 2006; Hopp Preferences for LSTs among older adults
& Duffy, 2000; Kwak & Haley, 2005; Mezey, are not consistent over time and appear to
Leitman, Mitty, Bottrell, & Ramsey, 2000). be associated with transient factors, such as
Close-knit families of all ethnic groups feel current health status, rather than core val-
that ADs are destructive to family cohesive- ues (Fried, O’Leary, Van Ness, & Fraenkel,
ness and find it unbelievable that there is 2007). As new health states emerge, what
a law that creates a barrier to family deci- was once intolerable and unacceptable (such
sion making (Mitty, 2001). Cultures differ as mild chronic pain and transient weak-
as well with regard to truth telling and dis- ness) becomes tolerable and acceptable,
closure (Kagawa-Singer & Blackhall, 2001). hence the instability of choices. Variability
Asian and Hispanic/Latino patients prefer was somewhat associated with treatment
family participation in decision making in burden or the risk of a (further) impaired
contrast to White and Black patients who health status.
prefer patient-centered or patient-directed Hospitalized older adults (>60 years)
decision making (Kwak & Haley, 2005). As with LWs that indicated wishes for limited
many have shown, White patients are more care or comfort care were more likely to have
informed about, interested in, and likely their preferences honored than hospitalized
to discuss treatment preference, execute a older adults without an LW (Silviera, Kim, &
living will (LW), refuse certain LSTs, and Langa, 2010). Patients with an HCP were less
appoint an HCP than Black or Hispanic/ likely to receive all care possible or die in the
Latino patients (Hopp & Duffy, 2000; Kwak hospital than were patients without a desig-
& Haley, 2005). White patients with higher nated decision maker.
education and income levels are more likely The physician orders for life-sustaining
to complete an AD than Black and Hispanic/ treatments (POLST) is intended to surmount
Latino patients with less than a high school the barriers and problems associated with tra-
education and low income levels (Mezey ditional EOL treatment orders and processes.
et al., 2000). in comparison with Mexican it not only reflects a patient’s preferences
American and Euro-Americans, Black about CPR but also includes medical orders
patients are more likely to want LST to pro- about hospitalization, antibiotics, ANH, com-
long life (Hopp & Duffy, 2000) and believe fort measures, and medical interventions (e.g.,
that having an AD legalizes denial of access iV fluids, intubation). Known by a variety of
to care (Perkins, Geppert, Gonzales, Cortez, names, such as the physician orders for scope
& Hazuda, 2002). Same-race peer mentors of treatment (POST) or the medical orders
had a positive effect on ACP among Black for life-sustaining treatments (MOLST), the
but not White patients with regard to AD POLST is associated with reduced unwanted
completions (Perry et al., 2005). hospitalization, improved documentation of
Black more than White family members NH residents’ wishes, fewer traditional DNR
report communication problems regarding orders, and fewer full-code orders (Hickman
being informed and supported for what the et al., 2010). Consistency over time has not
family says are the patient’s treatment wishes been reported.
or are stated in the patient’s AD (Welch, Teno,
& Mor, 2005). Overall, having an AD means Ethel L. Mitty