Racial Disparities in End-of-Life Care Between Black and White Adults With Metastatic Cancer

Perry, Laura M.; Walsh, Leah E.; Horswell, Ronald; Miele, Lucio; Chu, San; Melancon, Brian; Liu, John; Blais, Christopher M.; Rogers, James L.; Hoerger, Michael

doi:10.1016/j.jpainsymman.2020.09.017

Cited by 28 publications

(23 citation statements)

References 49 publications

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“…Despite well-documented racial disparities in hospice and end-of-life acute care use in the United States, 2,21-23,28,29 race and ethnicity did not predict hospice enrollment among PCC patients in our study. Medicaid status was the only variable that explained discharge to hospice.…”

Section: Discussioncontrasting

confidence: 88%

“…Given disparities in patient-clinician communication about end-of-life wishes [3][4][5] and racial and ethnic minority patients' lower odds of naming a healthcare agent to make care decisions if needed, 2,14 racial and ethnic minorities with serious illness may be disadvantaged in the quality of care they receive if they are unable to make decisions themselves. 2 In the context of poorer communication and factors such as socioeconomic status, access to quality healthcare, religiosity, culture, and clinician biases or racism, 13,[15][16][17][18] racial and ethnic minority patients undergo more care transitions near the end-of-life, 19 experience more hospital readmissions, 20 are more likely to have aggressive end-of-life care, 2,[21][22][23] and report lower quality end-of-life care. [24][25][26][27] Evidence of racial and ethnic minority patient enrollment in hospice is mixed with some studies indicating minority patients are less likely to enroll or stay enrolled in hospice than White patients [28][29][30] and other studies suggesting Black/African American palliative care patients 31,32 and Latinx palliative care patients are as likely as White patients 30 or, in the case of Latinx palliative care patients, more likely than White patients 31 to be discharged to hospice.…”

Section: Introductionmentioning

confidence: 99%

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Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Starr

Ulrich

Pérez

et al. 2021

Am J Hosp Palliat Care

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Background: Palliative care consultation to discuss goals-of-care (“PCC”) may mitigate end-of-life care disparities. Objective: To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs. Methods: This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital. Results: In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = −3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race. Conclusions: Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.

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Section: Discussioncontrasting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Starr

Ulrich

Pérez

et al. 2021

Am J Hosp Palliat Care

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“…Some of the most profound spiritual experiences I have had in my life were mediated through encounters with African American women who self-identify as "prayer warriors" and stand out to me as spiritual giants. I envision a remote clearinghouse and/or work-at-home setup for many of these women, [6] trained for spiritual intervention in end-of-life contexts, virtually available to doctors on a point-of-care basis, to provide an earnest and nuanced prayer for miraclehoping families. Seamlessly integrating this spiritual intervention into "goals of care" conversations with physicians is critical for three reasons.…”

Section: Resultsmentioning

confidence: 99%

Honoring Black Hopes: How to respond when the family is hoping for a miracle

Stonestreet¹

2022

F1000Res

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Background: Racial and ethnic disparities in end-of-life healthcare can be reduced by showing physicians how to best respond to a documented underlying cause: African American families’ hopes for a miracle via divine intervention influence their end-of-life medical decisions, like, for example, making them not want to withdraw ventilatory support in cases of poor neurologic prognosis because they are still hoping for God to intervene. Methods: Autoethnographic research probing the author’s Spiritual Care experience in this context yields a nuanced, 90-second point-of-care spiritual intervention physicians can use to address the religious aspect of African American families who base end-of-life medical decisions on their hopes for a miracle via divine intervention. Autoethnographic analysis is framed by physician-author, Dr. Jessica Zitter’s documented journey of grappling with this context. The evolution of Dr. Zitter’s responses to miracle-hoping African American families provides a framework for applying autoethnographic analysis to a critical appropriation of the Johns Hopkins “AMEN” communication protocol for families hoping for a miracle. Results: The common instinct of white physicians to remain neutral, holding miracle-hoping African American families at arm’s length, rather than supportively engaging their hopes, is shown to be an intellectual ruse for emotional avoidance. A novel, counterintuitive spiritual intervention for the religious aspect of miracle-hoping African American families is integrated into an existing physician communication protocol for responding to families hoping for a miracle with recommendations for utilization of existing communication technology when necessary. Conclusion: Properly addressing the religious dimension of African American families hoping for a miracle may help physicians to increase their therapeutic connection with families, decrease their own stress/burnout levels, and eliminate racial and ethnic disparities in end-of-life healthcare.

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“…This study analyzed data from the Research Action for Health network (REACHnet). As described further by Perry et al 18 . REACHnet is one of 13 Clinical Data Research Networks funded by the Patient‐Centered Outcomes Research Institute (PCORI).…”

Section: Methodsmentioning

confidence: 99%

Anxiety, depression, and end‐of‐life care utilization in adults with metastatic cancer

et al. 2021

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Objective End‐of‐life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end‐of‐life care in metastatic cancer. Methods This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011–12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. Results Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. Conclusions Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end‐of‐life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end‐of‐life care.

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Racial Disparities in End-of-Life Care Between Black and White Adults With Metastatic Cancer

Cited by 28 publications

References 49 publications

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Honoring Black Hopes: How to respond when the family is hoping for a miracle

Anxiety, depression, and end‐of‐life care utilization in adults with metastatic cancer

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