Palliative & Supportive Care

Physician perspectives on end-of-life care: Factors of race, specialty, and geography

CINDY L.  CARTER  Ph.D. a1 c1 , JANE G.  ZAPKA  Sc.D. a2 , SUZANNE  O'NEILL  Ph.D. a3 , SUSAN  DesHARNAIS  Ph.D. a4 , WINNIE  HENNESSY  R.N., M.S. a2 , JEROME  KURENT  M.D. a5 and RICKEY  CARTER  Ph.D. a2
a1 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
a2 Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA
a3 Department of Psychology, University of North Carolina, Chapel Hill, North Carolina, USA
a4 Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
a5 Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

Article author query
carter cl   [PubMed][Google Scholar] 
zapka jg   [PubMed][Google Scholar] 
oneill s   [PubMed][Google Scholar] 
desharnais s   [PubMed][Google Scholar] 
hennessy w   [PubMed][Google Scholar] 
kurent j   [PubMed][Google Scholar] 
carter r   [PubMed][Google Scholar] 


Objectives: To describe physicians' end-of-life practices, perceptions regarding end-of-life care and characterize differences based upon physician specialty and demographic characteristics. To illuminate physicians' perceptions about differences among their African-American and Caucasian patients' preferences for end-of-life care.

Design and methods: Twenty-four African-American and 16 Caucasian physicians (N = 40) participated in an in-person interview including 23 primary care physicians, 7 cardiologists, and 10 oncologists. Twenty-four practices were in urban areas and 16 were in rural counties.

Results: Physicians perceived racial differences in preferences for end-of-life care between their Caucasian and African-American patients. Whereas oncologists and primary care physicians overwhelmingly reported having working relationships with hospice, only 57% of cardiologists reported having those contacts. African-American physicians were more likely than Caucasian physicians to perceive racial differences in their patients preferences for pain medication.

Significance of results: Demographic factors such as race of physician and patient may impact the provider's perspective on end-of-life care including processes of care and communication with patients.

(Received January 3 2006)
(Accepted March 26 2006)

Key Words: Physician survey; Patient preferences; African-American; End-of-life; Pain management.

c1 Corresponding author: Cindy L. Carter, Ph.D., Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC 29425, USA. E-mail: