Purpose: Although the mortality rate of end-stage renal disease (ESRD) is high among African Americans, little is known about whether patients' perceived risk of mortality coincides with the prognosis based on their medical conditions and whether a high risk of mortality would influence patients' end-of-life treatment choices. There is a general belief that African Americans are likely to continue life-sustaining treatment near end-of-life and yet the associations among these variables have not been well studied.

Methods: Fifteen male and 13 female African Americans (M [SD]=57.9 [13.7] years of age) with ESRD completed the following measures: 1) the Perceived Outcomes of Dialysis and Risk of Mortality and 2) Goals of Care at the End-of-Life. Their medical records were reviewed to identify 1-year mortality risk using Charlson Comorbidity Index (CCI).

Results: According to CCI scores, 75% of this sample of African Americans had a 27% 1-year mortality risk. Of those, 12 had a 50% 1-year mortality risk (CCI „d 8). There was a moderate correlation between CCI and patients' perceived risk for developing a life-threatening complication in the next year or two (r = .42, p = .014). However, there was no association between CCI and perceived risk of mortality. Most patients believed that they would live as long as other people at their age without kidney disease. More than 80% of the sample chose the goals of care to be focused on comfort and peace and stated that they would not want life-sustaining treatment, including dialysis if they developed a serious stroke or heart attack. Such preference for comfort care in situations of a low chance of survival was persistent in the sample regardless of their CCI-based prognosis or perceived risk of mortality.

Conclusions: There was a discrepancy between patients' perceived risk for mortality and actual medical prognosis. ESRD African Americans' end-of-life choices did not appear to be influenced by perceived outcomes of dialysis or risk of mortality. The findings suggest that interventions are needed to bridge the gap between patients' understanding of illness progression and actual medical prognosis. African Americans in this sample did not highly favor life-sustaining treatment if death is near. Future research is needed to further examine how perceived risk of mortality influences advance care planning and end-of-life decision making.