Moving beyond the impasse: discussing death and dying with African American patients.

This article offers a historical and cultural lens through which physicians can gain a better understanding of patient-provider conflict in end-of-life discussions with African American patients and their families. Just as a practitioner would not prescribe a medication to treat a symptom without first determining its underlying cause, it is unwise, and usually ineffective, to try to discuss end-of life care with patients without first understanding the context that shapes their perspectives on death and dying. The first section of this article provides a historical and sociological context to understand the source of the patient-provider conflicting perspectives. I argue that historical factors, such as dying prematurely and experiencing unequal treatment in the health care system, along with cultural factors shaped by faith traditions, contribute to preferences for more aggressive treatment and resuscitative care at the end of life. The second section offers providers a framework-guided by Four Fs: encourage Faith, address Fear, consider Finances, and avoid Futility-to help address these conflicts and effectively navigate end-of-life discussions with African American patients and families.