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Racial differences in predictors of intensive end-of-life care in patients with advanced cancer

TitleRacial differences in predictors of intensive end-of-life care in patients with advanced cancer
Publication TypeJournal Article
Year of Publication2009
AuthorsLoggers, ET, Maciejewski, PK, Paulk, E, DeSanto-Madeya, S, Nilsson, M, Viswanath, K, Wright, AA, Balboni, TA, Temel, J, Stieglitz, H, Block, S, Prigerson, HG
JournalJ Clin OncolJ Clin Oncol
Volume27
Pagination5559-64
Date PublishedNov 20
ISBN Number1527-7755 (Electronic)<br/>0732-183X (Linking)
Accession Number19805675
KeywordsAdvance Care Planning/ trends, African Americans/ ethnology, Aged, Aged, 80 and Over, Attitude to Death/ ethnology, Caregivers/statistics & numerical data, Cohort Studies, Continental Population Groups/ethnology, Critical Illness/therapy, European Continental Ancestry Group/ ethnology, Female, Humans, Male, Middle Aged, Neoplasm Staging, Neoplasms/diagnosis/ethnology/ therapy, Odds Ratio, Predictive Value of Tests, Probability, Prospective Studies, Resuscitation Orders, Risk Assessment, Survival Analysis, Terminal Care/trends
AbstractPURPOSE: Black patients are more likely than white patients to receive life-prolonging care near death. This study examined predictors of intensive end-of-life (EOL) care for black and white advanced cancer patients. PATIENTS AND METHODS: Three hundred two self-reported black (n = 68) and white (n = 234) patients with stage IV cancer and caregivers participated in a US multisite, prospective, interview-based cohort study from September 2002 to August 2008. Participants were observed until death, a median of 116 days from baseline. Patient-reported baseline predictors included EOL care preference, physician trust, EOL discussion, completion of a Do Not Resuscitate (DNR) order, and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. RESULTS: Although black patients were three times more likely than white patients to receive intensive EOL care (adjusted odds ratio [aOR] = 3.04, P = .037), white patients with a preference for this care were approximately three times more likely to receive it (aOR = 13.20, P = .008) than black patients with the same preference (aOR = 4.46, P = .058). White patients who reported an EOL discussion or DNR order did not receive intensive EOL care; similar reports were not protective for black patients (aOR = 0.53, P = .460; and aOR = 0.65, P = .618, respectively). CONCLUSION: White patients with advanced cancer are more likely than black patients with advanced cancer to receive the EOL care they initially prefer. EOL discussions and DNR orders are not associated with care for black patients, highlighting a need to improve communication between black patients and their clinicians.
Ethno Med: