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Racial differences affect end-of-life choices, says researcher

by Karen Singer - November 28, 2005

Elderly African-Americans need to know more about end-of-life treatment options that could help support them and their families, says Karen Bullock.

Bullock, an assistant professor of social work, is conducting research comparing preferences for medical treatment among older African-Americans and Caucasians.

She says many African-Americans choose aggressive treatment when there is little chance of improvement, because they don’t know about living wills or palliative care.

Her study is supported by a $100,000 grant from the Gerontological Society of America and The John A. Hartford Foundation.

She is comparing end-of-life care experiences, types of treatments, and other factors that influence end-of-life care in an acute care setting.

The subject is close to her heart.

“I know, personally, that cultural barriers exist,” says Bullock, whose mother died of lung cancer several years ago. The condition was far advanced by the time it was diagnosed.

“Hospice would have been wonderful for her, but she refused it,” says Bullock, who was her mother’s primary caregiver.

“There’s a tremendous need for work in this area,” she adds, “and I really want to do something to break down those barriers.”

Bullock has been involved with eldercare and end-of-life issues for several years, including serving as the director of the School of Social Work’s Resource Enrichment Center, which was established under a grant from the Soros Foundation/Project on Death in America. The goal of the Soros program is to develop a web-based resource enrichment center on end-of-life issues and information for social workers.

Karen Bullock, assistant professor of social work.
Karen Bullock, assistant professor of social work.
Photo by Peter Morenus

Bullock thinks racial differences contribute to end-of-life decisions, and that African-Americans are less likely to have prepared living wills that explain their medical wishes, or to choose palliative care – treatment that focuses on symptom management and comfort care when there is no known cure.

“Many older African-Americans receive aggressive treatment when there is little chance of improvement in their condition, because they feel without it they won’t receive adequate care,” she says.

Many of them do not know about living wills, she adds, and may be suspicious when told that these directives can help patients have a “good death.”

Bullock will use data from Hartford Hospital to compare end-of-life treatment between groups of African-Americans and Caucasians who died over a two-year period.

“We need evidence-based research on which to make recommendations before we can develop strategies for integrating culturally specific components into our care and to increase the utilization of palliative care within the African-American community,” Bullock says.

“We’ve got a lot of work to do.”

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