The two purposes of this study were 1.) to assess whether certain characteristics of patients with AIDS and of their physicians were associated with the likelihood of discussing life sustaining treatment and 2.) to determine if differences in patient-physician discussions regarding this care were related to patients’ desires to communicate with their physician about this issue.

The study participants were recruited from three sites in Boston, Massachusetts that provided care to more than 20% of AIDS patient in surrounding areas. The participants were interviewed and information was collected on “demographic and socioeconomic characteristics, illness-related factors, use of health care services, health status, preferences for resuscitation, and whether preferences for resuscitation had been discussed with their physician.” The physician “most responsible for the care of each patient” was also interviewed (or a respective physician informant) at each site. The investigators hypothesized that “patients treated by physicians with demographic characteristics similar to those of the patients would be more likely to discuss their preferences for care.”

Only 38% of patients had discussed their preferences for life-sustaining care with their physician, yet 72% reported wanting to have this discussion with their provider. Further, those patients who were less likely to have discussed this preference with their physician were nonwhite rather than white (26% vs. 42%), had lower pre-illness income (25% vs. 41%), were heterosexual (25% vs, 43%), had poorer physical functioning, had an AIDS diagnosis for no longer than 1 year, or were taking zidovudine.

After adjustment for possible confounders, only race, previous hospitalization and affiliation with an HMO healthcare system remained statistically significantly as to whether or not the patient had discussed a preference with the physician. More importantly, race remained an independent predictor of patient-physician communication, whereas socioeconomic factors, such as level of education and income, were not. Overall, the results clearly indicated that nonwhites, as compared to whites, were significantly less likely to have discussed their preference for life-sustaining care with their physicians.

Interestingly, among nonwhites, “56% of those with a nonwhite provider had discussed resuscitation compared with 22% of those with a white physician (P=.03).” However, for white patients, “physician characteristics were not associated with the discussion of preferences for life sustaining care.” The authors noted that “it is unlikely that the practices of a few physician explain [the] findings” since the characteristics of over 25 physicians were measured and no physician cared for more than 13 patients.

When examining the relationship between patient desire for communication and race, the authors found that “among those who had not discussed resuscitation with their physician, 75% of nonwhites wanted to do so, as did 71% of whites.” The investigators concluded, “patient desire to discuss life-sustaining care, therefore, does not seem to explain the observed racial differences in patient-physician communication.”

In summary, “nonwhites appear to be at significant risk for not discussing their preferences for life-sustaining care, with no clinical rationale.” Although a possible explanation is that “differences in communication by race reflect a greater desire for patient-physician communication among whites,” the results of this study clearly refute this hypothesis since “the desire to discuss the issue is similar among whites and nonwhites.” The authors suggest that “the different patterns of discussion among nonwhite patients in relation to the race of their provider suggest that the inadequacy in patient-physician communication may be mediated in part by ‘mismatch’ of patient and provider race.” Nonetheless, the authors recommend that since “particular groups of patients appear to be at higher risk for this failure in communication, interventions to improve communication should target these populations.”