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Advance Care Planning: Does Patient Gender Make a Difference?

https://doi.org/10.1097/00000441-200401000-00006Get rights and content

ABSTRACT

Background

Although it has received little study, gender may significantly affect patients' attitudes about advance care planning.

Methods

We asked 26 Mexican American (14 male, 12 female), 18 European American (7 male, 11 female), and 14 African American (7 male, 7 female) inpatients for their attitudes about advance care planning and dying. Coders of different ethnicities and genders performed independent, blinded content analyses of responses.

Results

The interviews identified 40 themes. Five, including “Advance directives (ADs) improve the chances a patient's wishes will be followed,” characterized both genders of all 3 ethnic groups. Although no individual themes distinguished the genders across ethnic groups, 3 meta-themes—or clusters of related themes—did. Men's end-of-life wishes addressed functional outcome alone, but women's wishes addressed other factors, too. Men felt disempowered by the health system, but women felt empowered. Men feared harm from the system, but women anticipated benefit. Each ethnic group expressed these gender differences uniquely. For example, most Mexican American men preferred death to disability, believed “the health care system controls treatment,” and wanted no “futile” life support. In contrast, most Mexican American women expressed wishes only about care other than life support (especially about when and where they wanted to die), believed ADs “help staff know… (such) wishes,” and trusted the system to “honor (written) ADs.”

Conclusion

Core cultural attitudes observed in both genders of 3 ethnic groups may extend to all Americans. Although core attitudes may support advance care planning for many Americans, health professionals should consider tailoring it to other, ethnic- and gender-specific attitudes.

Section snippets

Methods

As we described in a prior article,7 this hypothesis-generating study used a purposive sampling of 58 Mexican American, European American, and African American inpatients aged 50 to 79 and recruited at either a private community hospital or a public teaching hospital in San Antonio, Texas. All subjects actively suffered from at least one of 10 common internal medicine diagnoses. Sixty-two percent had either congestive heart failure or angina. A validated algorithm classified subjects by ethnic

Results

The 58 subjects included 14 male and 12 female Mexican Americans, 7 male and 11 female European Americans, and 7 male and 7 female African Americans. Within each ethnic group, the genders were similar by age, number of screening diagnoses, religion, and educational level but differed by marital status, occupational group,26 and employment status (Table 1). The genders for European Americans also differed by the Duncan Socioeconomic Index,27 and the genders for Mexican Americans and African

Discussion

Ethnic culture surely shapes patients' attitudes about end-of-life care.28 Gender subcultures within ethnic culture probably also play a role. Although we studied in depth just 3 American ethnic cultures, our data suggest that most or all such cultures may share certain core attitudes about end-of-life care. While embracing those core attitudes, each American ethnic culture may hold other attitudes distinctive to that culture. Similarly, while embracing such ethnically distinctive attitudes,

Acknowledgements

Melissa Heinz Bennett, MPH, and Lucille Quinn conducted the interviews; Cynthia M. A. Geppert, MD, PhD, and Adelita Gonzales, RN, helped code transcripts; and Kathryn E. Artnek, RN, PhD, reviewed subjects' medical records. Susan Bagby, Andrew K. Diehl, MD, and D. Krysten James, BBA, made helpful suggestions about earlier drafts.

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