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A Literature Review of Preferences for End-of-Life Care in Developed Countries by Individuals With Different Cultural Affiliations and Ethnicity

Thomas, Roger MD, PhD, CCFP, MRCGP; Wilson, Donna M. PhD, RN; Justice, Christopher PhD; Birch, Stephen DPhil; Sheps, Sam MD, MSc

Journal of Hospice & Palliative Nursing: May-June 2008 - Volume 10 - Issue 3 - p 142-161
doi: 10.1097/01.NJH.0000306740.10636.64

Anticipatory decision making about end-of-life care is predominantly a North American concept. Researchers investigated four themes: advance directives, life support, communication, and decision making. Substantial differences exist among cultural groups in the percentages with living wills/advance directives, and they are less frequent for those with family-centered decision making or with less trust in the healthcare system. African Americans prefer life support more than Asian Americans or European Americans. Cultural groups vary in their preferences about communicating terminal diagnoses. Non-English-speaking patients perceive communication as a barrier to care. Mexican Americans, Korean Americans, and Canadian First Nations emphasize family-based decision making at the end of life, and European Americans emphasize patient autonomy.

Author Affiliations: Roger Thomas, MD, PhD, CCFP, MRCGP, is Professor, Department of Family Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada.

Donna M. Wilson, PhD, RN, is Caritas Nurse Scientist and Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Christopher Justice, PhD, is Co-Director, Inquiry in Higher Education Research Project, Centre for Leadership in Learning, McMaster University, Hamilton, Ontario, Canada; and Assistant Professor, Department of Public Health Sciences, University of Toronto, Dundas, Ontario, Canada.

Stephen Birch, DPhil, is Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Sam Sheps, MD, MSc, is Professor and Director, Western Regional Training Centre in Health Services Research, Department of Healthcare and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence to Roger Thomas, MD, PhD, CCFP, MRCGP, Department of Family Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada T2N 1MY (

The authors declare no conflict of interest.

© 2008 The Hospice and Palliative Nurses Association