Relationships Between Psychosocial-Spiritual Well-Being and End-of-Life Preferences and Values in African American Dialysis Patients

The objective of the study was to examine whether psychosocial and spiritual well-being is associated with African American dialysis patients' end-of-life treatment preferences and acceptance of potential outcomes of life-sustaining treatment. Fifty-one African Americans with end-stage renal disease (ESRD) completed a sociodemographic questionnaire and interview with measures of symptom distress, health-related quality of life, psychosocial and spiritual well-being, and preferences and values related to life-sustaining treatment choices. The subjects were stratified by end-of-life treatment preferences and by acceptance of life-sustaining treatment outcomes, and compared for psychosocial and spiritual well-being, as well as sociodemographic and clinical characteristics. Individuals who desired continued use of life-sustaining treatment in terminal illness or advanced dementia had significantly lower spiritual well-being (P = 0.012). Individuals who valued four potential outcomes of life-sustaining treatment as unacceptable showed a more positive, adaptive well-being score in the spiritual dimension compared with the group that valued at least one outcome as acceptable (P = 0.028). Religious involvement and importance of spirituality were not associated with end-of-life treatment preferences and acceptance of treatment outcomes. African Americans with ESRD expressed varied levels of psychosocial and spiritual well-being, and this characteristic was associated with life-sustaining treatment preferences. In future research, the assessment of spirituality should not be limited to its intensity or degree but extended to other dimensions.