By MIKE GOODKIND

When LaVera Crawley's mother decided to enter a hospice program in the weeks before her death, Crawley was acutely aware ­ both personally and professionally ­ that her mother's decision was somewhat unique for an African-American woman.

"I found there is a real sense of struggle which may specifically deter African-Americans from wanting to give up fighting in the face of death," said Crawley, a physician-lecturer at Stanford University Medical Center. "And there is also sometimes a subtle suspicion which can make an African-American family feel they are being ‘given up on' when a caregiver suggests a hospice."

Crawley's perspective comes from a lifetime of studying how African-Americans deal with end-of-life issues. She was recently named executive director of the Initiative to Improve Palliative Care for African-Americans. Her duties include staging a national conference in New York on Jan. 4, 2002, that will bring together experts in the field of palliative care as well as major philanthropists, health providers and African-American organizations.

She said caregivers should understand that African-Americans often view palliative care from a tradition of struggling against death that dates back to the times of slavery and segregation, as well as from a predominantly Christian background that has roots in African religions.

"Although socioeconomic status may be a greater determinant than race of how people respond to issues of death and dying, there are some issues and trends which appear to be highly focused in the African-American community," said Crawley, who received her MD from Meharry Medical College, an historically black college in Nashville.

Crawley noted that her mother received superb proactive care for a rare form of cancer in Cincinnati in 1989 and her family was comfortable with the decision to seek hospice care during her last weeks.

"Most of the care was not ethnic-specific, but I can think of a few subtle events which reminded me that we need to look carefully at how African-Americans might have unique needs and ways of looking at care," she said.

For instance, Crawley said she was taken aback when a white nurse suggested that her mother's quality of life had deteriorated to an extent that death might be preferable. In the African-American community, the need to struggle can overshadow concerns about quality of life, she said. "In some sense, African-Americans feel they must cling to life whenever it is present. On the other hand, people without a sense of struggle might be comforted by a nurse who gives permission to ‘let go' of a loved one," she said. "There are differences."

The coalition Crawley now heads is a collaboration of Memorial Sloan-Kettering Cancer Center, Harlem Palliative Care Network and Stanford's Center for Biomedical Ethics, where Crawley serves as a lecturer. She also teaches classes focused on palliative care and cultural diversity for the Stanford Faculty Development Program and is involved in several ongoing research studies. A prolific writer, she is particularly interested in using narrative human-interest stories as educational vehicles.

Crawley came to Stanford as a research fellow and later a Soros Faculty Scholar, working on the Project on Death in America. Before that she completed a variety of assignments including a stint as a staff physician and director of prenatal services for the Indian Health Service on the Navajo reservation in Arizona. She was chief resident in family practice at UCSF from 1995-96.

Crawley lives with her husband, Alec, and their 13-year-old son, Sam.

"Medical Center Report" will provide human-interest stories about faculty and staff members at the medical center on a regular basis. If you'd like to suggest someone for a future profile, please contact Mike Goodkind at goodkind@stanford.edu.