End-of-life preferences and presence of advance directives among ethnic populations with severe chronic cardiovascular illnesses

Abstract

Background:

Little end-of-life planning occurs among ethnic minorities with severe cardiovascular illnesses.

Aim:

The purpose of this study was to explore end-of-life preferences and determine the presence of signed end-of-life advanced directives.

Methods:

Thirty ethnic minority patients volunteered for an open-ended question interview. Content analysis was used to summarize responses into themes using patients’ terms.

Findings:

Five themes emerged: (a) importance of family involvement in care at end of life; (b) being pain free (or pain controlled) at the end of life; (c) having a comfortable environment for death was desired; (d) wanting no procedures for prolonging life; and (e) desiring a relationship with a professional for end-of-life decision making (reported as inconsistently available). New unique findings were related to concerns about multiple and repeatedly rotating professionals not allowing these ethnic patients end-of-life discussions and fear that signing forms would lead to deportation. Overall, 50% of the participants had signed standard advanced directives as requested upon entry to the home care agency.

Conclusions:

Most of these very ill patients did readily discuss these sensitive issues with the research nurse. Cardiovascular training in end-of-life care should include sensitivity to ethnic and cultural preferences and competencies in interviewing on sensitive topics.