Physician cultural sensitivity in African American advance care planning: a pilot study.

BACKGROUND: 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. METHODS: A cross-sectional self-report questionnaire was distributed to 236 physicians at three major teaching hospitals. RESULTS: 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). CONCLUSION: 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.

Sexual problems among a specific population of minority women aged 40-80 years attending a primary care practice.

INTRODUCTION: Clinicians are embarrassed about discussing sex with patients and do not know how to ask about sexual problems in a way that will optimize honest and open responses. Learning about inquiry responses and the prevalence of sexual problems among specific groups of women, including minority women, can help identify appropriate inquiry and management pathways. AIM: To better understand useful inquiry techniques as well as to describe the prevalence of sexual problems among a specific group of minority women aged 40-80 years. MAIN OUTCOME MEASURES: Responses to two styles of sexual problem inquiry, direct vs. ubiquity, were compared among sexually active subjects. Prevalence of sexual problems and interest in discussing problems with personal clinician were determined. METHODS: Minority women aged 40-80 years receiving care at one of two Family Health Centers in Brooklyn, New York who could speak English met inclusion criteria. A cross-sectional survey of 212 subjects, the majority being Afro-Caribbean, identified those who were sexually active and then randomly asked about sexual problems using one of two inquiry types: (i) a direct question, such as "Do you have a problem during sex," or (ii) a ubiquity-style question, such as "Many women with diabetes have sexual problems, how about you?" Sexual problems were characterized by recognized phases of female sexual activity. Interest in discussing sexual problems with a personal clinician was determined. RESULTS: Of the 212 women surveyed, 108 (50.9%) were sexually active with 37 (34.3%) of these women responding "yes" when asked about sexual problems using one of the two inquiry techniques. Stratified analysis by age group showed significantly higher reporting of sexual problems when a ubiquity-style inquiry was used among older women aged 61-80 years (P = 0.028) but not among younger ones. The prevalence of sexual problems was 14.8% reporting pain, 12.0% lack of interest, 9.2% lack of excitation, 5.5% lack of orgasm, and 6.5%"other." Forty-three percent of women with problems said they would like to discuss their problem(s) with their clinician. CONCLUSIONS: In a specific minority group of women aged 40 years and older, especially those over age 60 years, ubiquity-style inquiries may encourage more open and honest responses about sexual problems. The most common sexual problem among this group of women was pain. There is willingness and even interest in talking with clinicians about sexual issues. Recognition of sexual problem prevalences helps clarify the high number of women who could be potentially helped with current and future pharmacologic and psychosocial treatments.