Background: Studies of end-of-life care have shown that Latino patients want more aggressive care compared to white patients. While this has been attributed to aspects of ethnicity, national origin, and religion, it is possible that limited education might obscure the true relationship between Latino patients and their end-of-life care preferences.
Methods: Spanish-speaking subjects presenting to their primary care doctors were asked their preferences for end-of-life care before watching a video of advanced dementia. Subjects then viewed a 2-minute video of a patient with advanced dementia and were asked again about their preferences. Unadjusted and adjusted logistic regression models were fit using stepwise algorithms to examine factors related to preferences.
Results: A total of 104 subjects completed the interview. Before seeing the video, 42 (40%) subjects preferred comfort care; 43 (41%) desired life-prolonging care; 11 (11%) chose limited care; and 8 (8%) were unsure of their preferences. Subject preferences changed significantly after the video: 78 (75%) of the subjects chose comfort care; 8 (8%) desired life-prolonging care; 14 (13%) chose limited care; and, 4 (4%) were unsure of their preferences (p < 0.001). Unadjusted and adjusted analyses revealed a statistically significant difference regarding prevideo preferences based on educational level. After the video, differences in preferences based on educational level disappeared.
Conclusions: Educational level was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. After viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to educational level. These findings suggest that educational level is an important variable to consider in research and in patient care when communicating about end-of-life care preferences. While attention to patients' culture is important, it is also important to avoid ascribing choices to culture that may actually reflect inadequate comprehension. Attention to communication barriers with techniques like the video used in the current study may help ensure optimal end-of-life care for Latino patients irrespective of educational level.