2. Physician-Based Factors

Interviews and surveys of physicians suggest that many health care providers have limited knowledge about factors that contribute to ethnic differences in access and utilization of medical services by African American older adults.

\Wallace et al. (2007) surveyed 236 physicians at three teaching hospitals and reported that the majority of them were unfamiliar with specific end-of-life preferences of African American older adults who often do not have advanced directives and refuse referral to hospice and palliative care programs. Many whites and non-U.S. born black physicians did not perceive that the Tuskegee experiment had a significant impact on the medical decision-making of African American patients.

Suggestions for Improving Care of African American Older Adults

Because the physician’s perception of the patient is an important component of the working relationship, the authors (Wallace et al. 2007) advocated further cultural sensitivity training
to improve knowledge and hopefully care of the African American patient afflicted with
life-limiting illness.

The physician should assess the cultural background of each patient and inquire about the values that may affect care at the end of life.

Physicians should:

  • Utilize specific questions aimed at dealing with cross-cultural issues in end-of-life care (Searight, 2005)
  • Incorporate culturally-sensitive guidelines such as the Federal Cultural Linguistic Appropriate Services (CLAS): www.omhrc.gov/CLAS