Physician Cultural Sensitivity in African American Advance Care Planning: A Pilot Study

Abstract

Physician cultural sensitivity is particularly important for end-of-life care. This study correlates physicians' own racial background, clinical experience, and cultural sensitivity training with their attitudes, perceptions, and knowledge of advance care planning issues for African American patients. A cross-sectional self-report questionnaire was distributed to 236 physicians at three major teaching hospitals. Seventy-eight percent of all surveys were returned (183/236). The respondent racial characteristics were 53% white, 28% Asian, and 17% black. While 72% of physicians agreed that different ethnic groups have distinct attitudes towards advance directives, 58% acknowledged lack of familiarity with end-of-life preferences of African American patients. Black physicians (African American and non-U.S.-born) rated the cultural sensitivity training they received on a 0-10 Likert-type scale as 5.43 (n=28) versus a 3.74 rating by white physicians (n=91; p=0.022). Black physicians (African American and non-U.S.-born, n=27) rated their familiarity with advance care planning preferences of African Americans as 5.89 and white physicians (n=90) rated theirs as 4.14 on a 10-point Likert-type scale (p=0.002). Finally, 88% of U.S.-born black physicians (7/8) versus 35% of white physicians (32/91) perceived that the Tuskegee experiment has impacted African American medical decision-making (p=0.014). Similarly, a greater proportion of African American physicians perceived that the Tuskegee experiment has impacted African American medical decision making, compared to non-U.S.-born black physicians (88% (7/8) versus 26% (5/19), p=0.008). The majority of the physicians surveyed routinely provide end-of-life care and believe they are aware of racial differences in advance care planning. Yet, most were unfamiliar with specific end-of-life preferences of African American patients. We advocate for further research and cultural sensitivity training to improve end-of-life care for African American patients.