The purpose 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 socio-demographic 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 socio-demographic 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 = .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 to the group who valued at least one outcome as acceptable (p = .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
