The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

3035.0: Monday, November 17, 2003 - Board 9

Abstract #58055

Rural/urban differences in decision-making at the end of life: Family perspectives

Charles E. Gessert, MD, MPH, Division of Education and Research, St. Mary's/Duluth Clinic Health System, 400 East 3rd Street, Duluth, MN 55805-1853, 218-786-8176,, Barbara A. Elliott, PhD, School of Medicine, University of Minnesota, Duluth, 10 University Drive, Duluth, MN 55812, and Cynthia Peden-McAlpine, PhD, RN, School of Nursing, University of Minnesota - Twin Cities, 6-101 Weaver-Densford Hall, 308 Harvard St. S.E., Minneapolis, MN 55455.

Background: Rural/urban differences in the use of hospice, feeding tubes and other services near the end of life have been documented recently. However, little is known about underlying rural/urban differences in goals and values related to end-of-life care, or about rural/urban differences in the social construction of death. Methods: This study convened 8 focus groups comprised of 39 family members of cognitively impaired residents of rural and urban nursing homes. Sites were selected from Minnesota counties identified as urban or rural using USDA metro-nonmetro continuum codes. Participating family members were actively involved in caring for their relatives. The groups were guided through a discussion addressing (1) dementia and caregiving, (2) planning for end-of-life experiences, (3) making decisions, (4) preferences, (5) goals, (6) beliefs, and (7) values. The focus group sessions were recorded and transcribed; data was analyzed using qualitative research methods. Results: Participants differed substantially in their expectations of and interactions with the health care system, with rural families more likely to express appreciation for the care provided, and urban families more likely to position themselves as advocates and negotiators on behalf of their relatives. Most participants accepted the inevitability of death; rural families were more inclined to regard death as an unequivocal benefit. Participants described substantial sacrifices that had been made on behalf of their elderly family members. Discussion: The clinical and health policy implications of these findings for ethics in general and end-of-life care in particular will be discussed.

Learning Objectives:

Keywords: Rural Health, End-of-Life Care

Related Web page: None

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None This work is supported by a grant from the National Institute on Aging.
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Ethics Forum Poster Session

The 131st Annual Meeting (November 15-19, 2003) of APHA