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Leslie J. Blackhall, MD, MTS; Sheila T. Murphy, PhD; Gelya Frank, PhD; Vicki Michel, MA, JD; Stanley Azen, PhD

JAMA. 1995;274(10):820-825.

Abstract
Objective.
—To study differences in the attitudes of elderly subjects from different ethnic groups toward disclosure of the diagnosis and prognosis of a terminal illness and toward end-of-life decision making.

Design.
—Survey.

Setting.
—Thirty-one senior citizen centers within Los Angeles County, California.

Respondents.
—A stratified quota sample of 200 subjects aged 65 years and older self-identified as being from each of four ethnic groups: European American, African American, Korean American, or Mexican American (N=800).

Main Outcome Measures and Results.
—Korean Americans (47%) and Mexican Americans (65%) were significantly less likely than European Americans (87%) and African Americans (88%) to believe that a patient should be told the diagnosis of metastatic cancer. Korean Americans (35%) and Mexican Americans (48%) were less likely than African Americans (63%) and European Americans (69%) to believe that a patient should be told of a terminal prognosis and less likely to believe that the patient should make decisions about the use of life-supporting technology (28% and 41% vs 60% and 65%). Instead, Korean Americans and Mexican Americans tended to believe that the family should make decisions about the use of life support. On stepwise multiple logistic regression, ethnicity was the primary factor related to attitudes toward truth telling and patient decision making.

Conclusions.
—Korean-American and Mexican-American subjects were more likely to hold a family-centered model of medical decision making rather than the patient autonomy model favored by most of the African-American and European-American subjects. This finding suggests that physicians should ask their patients if they wish to receive information and make decisions or if they prefer that their families handle such matters.

(JAMA. 1995;274:820-825)

Author Affiliations
From the Department of Medicine, Pacific Center for Health Policy and Ethics (Dr Blackhall and Ms Michel); the Annenberg School for Communication (Dr Murphy); and the Departments of Occupational Therapy (Dr Frank) and Preventive Medicine (Dr Azen), University of Southern California, Los Angeles.

Footnotes
Reprint requests to the Division of General Internal Medicine, Unit 1, Room 8803, Los Angeles County and University of Southern California Hospital, 2025 Zonal Ave, Los Angeles, CA 90033 (Dr Blackhall).

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