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In addition to measurement
error, failure to account adequately for sociodemographic factors
may account for some of the difficulty in predicting utility from
health status. Cultural issues play a major role in medical decision-making
for seriously ill patients (Koenig
and Gates-Williams, 1995; Hallenbeck,
Goldstein et al., 1996; Koenig,
1997; Hallenbeck
and Goldstein, 1999; Ruhnke,
Wilson et al., 2000).
Several studies of
patient preferences for medical care for serious or terminal illness
have shown differences by race, with African American patients
requesting on average more life-sustaining treatments than their
white counterparts (Caralis
and Hammond, 1992; Caralis,
Davis et al., 1993; Garrett,
Harris et al., 1993). The differences in advance directive
choices by race of patients are mirrored in physicians' choices
for themselves (Mebane,
Oman et al., 1999).
Utility ratings can
differ significantly by socioeconomic factors (Katz,
Phillips et al., 1994; Roberge,
Berthelot et al., 1995), and by race and gender (Cykert,
Joines et al., 1999), although not all studies have confirmed
those associations.
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