Differences in end-of-life decision making among black and white ambulatory cancer patients

McKinley, Elizabeth D.; Garrett, Joanne M.; Evans, Arthur T.; Danis, Marion

doi:10.1007/bf02600155

Cited by 216 publications

(195 citation statements)

References 23 publications

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“…Decedents were also more likely than nondecedents to have had a discussion regarding prognosis and to have a DNR order. Although the majority of patients in our study did not have a formal AD, our documentation rate of 47% is considerably higher than previously reported rates of 20% 18 and 27% 4 among patients with cancer. There are some possible reasons for the higher rates of AD completion in our study population.…”

Section: Discussioncontrasting

confidence: 85%

Documentation and Discussion of Preferences for Care Among Patients With Advanced Cancer

Ahluwalia

Chuang

Antonio

et al. 2011

JOP

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9. Wright AA, Zhang B, Ray A, et al: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300: [1665][1666][1667][1668][1669][1670][1671][1672][1673] 2008 10. Temel JS, Greer JA, Admane S, et al: Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small cell lung cancer: Results of a randomized study of early palliative care. J Clin Methods:We prospectively abstracted the medical records of 118 patients receiving care at a Veterans Administration (VA) facility from diagnosis of stage IV disease to 12 months postdiagnosis or death. We used univariate statistics to describe the type and frequency of documentation of patient preferences and palliative care/hospice referral. We calculated the time from diagnosis to the first documentation of preferences and the time from first documentation to death. We compared documentation of patient preferences between decedents and nondecedents using 2 tests. Results:The majority of patients (81%) had some documentation of their care preferences recorded, although decedents were significantly more likely to have had their preferences documented than nondecedents (96% v 60%; P Ͻ .000). Most (53%) patients did not have a formal advance directive documented in the medical record. The mean time from diagnosis to the first documentation of preferences was approximately 2 months. More than half of all patients (53%) and almost threequarters of decedents (73%) had a palliative care consultation. Conclusion:Despite high rates of preference documentation, there remains room for improvement. Providers may need to be helped to identify patients earlier in their trajectory for appropriate palliative care services, and future work should focus on developing useful alternatives to advance directives for adequately documenting patient preferences.

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Section: Discussioncontrasting

confidence: 85%

Documentation and Discussion of Preferences for Care Among Patients With Advanced Cancer

Ahluwalia

Chuang

Antonio

et al. 2011

JOP

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“…First, our fi ndings showing that nonwhite patients were less likely to have advance directives are congruent with studies from non-ICU settings. 11,[25][26][27][28][29][30][31][32][33][34] Previous research suggests multifactorial causes for this difference, including diverse cultural beliefs and values, geographic variation in advance directive use, 32,[35][36][37] and disparities in patient-clinician communication about advance care planning. 12,14,15,26,34 Recent data support the potential value of advance directives in assuring that patients receive the care they would want.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICU

Muni

Engelberg

Treece

et al. 2011

Chest

171

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A growing body of evidence demonstrates the existence of important racial and ethnic differences in health care. Although many studies report on disparities in health care for acute and chronic conditions, 1-5 relatively few address racial disparities in the ICU, and those report confl icting fi ndings. Some have reported that black patients receive fewer medical interventions, 6,7 have shorter lengths of stay, and use fewer resources. 7 In contrast, others have found increased resource utilization, including larger numbers of ICU admissions and higher numbers of medical interventions for minority than for white patients. 8,9 Background: There is confl icting evidence about the infl uence of race/ethnicity on the use of intensive care at the end of life, and little is known about the infl uence of socioeconomic status. Methods: We examined patients who died in the ICU in 15 hospitals. Race/ethnicity was assessed as white and nonwhite. Socioeconomic status included patient education, health insurance, and income by zip code. To explore differences in end-of-life care, we examined the use of (1) advance directives, (2) life-sustaining therapies, (3) symptom management, (4) communication, and (5) support services. Results: Medical charts were abstracted for 3,138/3,400 patients of whom 2,479 (79%) were white and 659 (21%) were nonwhite (or Hispanic). In logistic regressions adjusted for patient demographics, socioeconomic factors, and site, nonwhite patients were less likely to have living wills (OR, 0.41; 95% CI, 0.32-0.54) and more likely to die with full support (OR, 1.59; 95% CI, 1.30-1.94). In documentation of family conferences, nonwhite patients were more likely to have documentation that prognosis was discussed (OR, 1.47; 95% CI, 1.21-1.77) and that physicians recommended withdrawal of life support (OR, 1.57; 95% CI, 1.11-2.21). Nonwhite patients also were more likely to have discord documented among family members or with clinicians (OR, 1.49; 95% CI, 1.04-2.15). Socioeconomic status did not modify these associations and was not a consistent predictor of end-of-life care. Conclusions: We found numerous racial/ethnic differences in end-of-life care in the ICU that were not infl uenced by socioeconomic status. These differences could be due to treatment preferences, disparities, or both. Improving ICU end-of-life care for all patients and families will require a better understanding of these issues.

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“…In such studies, ethnicity strongly affects the final endof-life decision. [12][13][14][15][16][17][18][19][20][21][22] In addition, in Korea and in other Asian nations, for most patients with malignant disease, family members do not want the patient to be informed of the exact status of his or her disease and sometimes do not even want the patient be informed that malignant disease has been diagnosed. The result is that patient autonomy cannot be procured at the time at which end-of-life decisions are made, and thus physicians usually discuss such decisions only with family members, who cannot always speak for the patient's exact treatment preferences.…”

mentioning

confidence: 99%

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

Kim

Lee

et al. 2004

Cancer

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BACKGROUND The role of the physician in end‐of‐life decision‐making is complicated. To analyze the controversies that surround therapeutic decision‐making and the withholding of life‐sustaining treatments, the authors compared values regarding therapeutic intervention that were held by physicians and family members of patients with terminal malignancies. METHODS One hundred fourteen patients with either advanced‐stage or terminal disease were enrolled in the current study. Questionnaires were administered to the duty physician and to patients' family members. The questions covered issues such as the use of new anticancer agents with only partial efficacy (15%) and the use of opioid analgesics, intravenous nutrition, feeding tubes, antibiotics, and hemodialysis. In addition, participants were asked about the administration of cardiopulmonary resuscitation (CPR) and the use of ventilators, and when the patient's family consented, the same questionnaire was administered to the patient as well. RESULTS Seventeen of 114 families refused to answer the questionnaire. Of the 97 available families, only 14 permitted access to the patient. Of those 14 patients, 5 refused to complete the questionnaire. Overall, 100% of families and 87% of patients had some knowledge regarding malignant disease, but only 69% of families and 37% of patients clearly understood the stage of the patient's disease. The use of a new agent with only partial efficacy (≈ 15%) was accepted by 41% of physicians and by 60% of families. The concordance rate between patients' physicians and family members regarding the same patient was 42%. The rankings of the acceptance of treatment by physicians were as follows: opioid analgesics, 100%; antibiotics, 91%; feeding tube, 87%; and intravenous nutrition, 78%. The rankings of the same items by family members were as follows: opioid analgesics, 92%; antibiotics, 89%; intravenous nutrition, 86%; and feeding tube, 75%. The concordance rates between patients' physicians and families were lowest for ventilator application (39%) and CPR (47%). CONCLUSIONS Values held on issues such as therapeutic decision‐making and the withholding of life‐sustaining treatment for patients with terminal malignancies were discordant between physicians and family members. To resolve controversies regarding the role of the physician in end‐of‐life decision‐making, the values of physicians, patients, and family members should be considered in the final decision‐making process. Cancer 2004. © 2004 American Cancer Society.

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Differences in end-of-life decision making among black and white ambulatory cancer patients

Cited by 216 publications

References 23 publications

Documentation and Discussion of Preferences for Care Among Patients With Advanced Cancer

Documentation and Discussion of Preferences for Care Among Patients With Advanced Cancer

The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICU

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

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