Wednesday, September 21, 2005

Couple of articles

A couple of recent articles...
July's J of the American Geriatrics Society has a piece about racial differences in the US in end of life care .  It is based on interviews with decedents identified from a US death certificate database & has all the problems associated with post-mortem interviews.  Nevertheless their findings are generally in line with previously described differences between African-Americans and whites w/r/t end of life care and medical care in general.  The decedents of the African-American patients reported more communication and accessibilty problems with physicians, more problems with lack of support of support of the family, less use of advanced directives, more financial burden from the death, and more use of 911 services, respirators, and feeding tubes in the last month of life.  Interestingly, perceived symptom control was similar across groups.  African-Americans were more likely to be cared for by a family member at home in the last month of life. 
The current Lancet continues its series on end of life perspectives from different faiths with the "traditional" Christian view.  We will have to wait for the less-than-traditional Christian view before it's clear what the authors mean by "traditional."  I have to admit I love the idea of this series but am getting a little disappointed with it.  This is supremely unfair & probably stems from my desire to get some good meaty answers to make things all-A-OK when I enter the room of someone from a different culture and faith tradition from me (which is probably most rooms).  This is clearly stupid.  On the other hand, and in contradistinction to the desire expressed above, it seems to me that the differences between patients and families within a culture or tradition are often just as great as the general differences between people from different traditions and, as a palliative care consultant, you have no idea what you're walking into when you enter that patient's room to talk about death.  Anyway, I'll end with a quote from the Lancet article:  We will all need to acknowledge that our culture is rent by profound religious and moral disagreements.

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