Palliative and Supportive Care

Original Articles

Ethnicity, race, and advance directives in an inpatient palliative care consultation service

Glenn B. Zaidea1, Renee Pekmezarisa1a2a3a4 c1, Christian N. Nouryana1, Tanveer P. Mira1, Cristina P. Sisona2, Tara Libermana1, Martin L. Lessera1a2a3a4, Lynda.B. Coopera1 and Gisele P. Wolf-Kleina1a3a4

a1 North Shore-LIJ Health System, New Hyde Park, New York

a2 Feinstein Institute for Medical Research, Manhasset, New York

a3 Hofstra North Shore-LIJ School of Medicine, Hempstead, New York

a4 Albert Einstein College of Medicine, Bronx, New York


Objective: Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).

Method: A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).

Results: Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.

Significance of results: This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.

(Received October 05 2011)

(Accepted October 27 2011)


  • PCC;
  • End of life;
  • Advance directive;
  • Race;
  • Ethnicity;
  • DNR;
  • DNI


c1 Address correspondence and reprint requests to: Renee Pekmezaris, North Shore-LIJ Health System, 175 Community Dr., Great Neck, NY 11021. E-mail: