Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients

Abstract

Context-African Americans are less likely to receive hospice care and more likely to receive aggressive end-of-life care than Whites. Little is known about how palliative care consultation to discuss goals-of-care (hereafter "PCC") is associated with hospice enrollment by race.Objectives-To compare enrollment in hospice at discharge between propensity-matched cohorts of African Americans with and without PCC, and Whites with and without PCC.Methods-Secondary analysis of a retrospective cohort study at a high-acuity hospital; employing stratified propensity-score matching for 35,154 African Americans and Whites age 18+ admitted for conditions other than childbirth or rehabilitation, who were not hospitalized at end of study, and didn't die during index hospitalization (hospitalization during which first PCC occurred).

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

“…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. However, a complex set of variables interact to influence a person's end-of-life decisions-not race or ethnicity alone.…”

Improved Serious Illness Communication May Help Mitigate Racial Disparities in Care Among Black Americans with COVID-19

“…14,18,19 Even when seriously ill, Black Americans are less likely than Whites to experience discussions with their healthcare providers about prognosis, personal goals, values, and end-of-life treatment preferences. 20 In addition, lack of racial diversity resulting from relatively low numbers of Black clinicians can further contribute to poorer communication quality, information-giving, patient participation, and participatory shared decision-making for Black patients compared to Whites. 15,21 In this paper, we argue that engaging palliative care early in patient care may help close racial gaps in coronavirus outcomes and that incorporating goals-of-care communication tools and training across settings and specialties may improve outcome disparities among Black Americans with COVID-19.…”

“…23 Citing fear of safety and efficacy of the vaccine and concern that vaccine development is not taking the needs of Black Americans into account, 2,23 half of Black adults report they do not plan to take the vaccine once one becomes available-even if it is free and scientists declare it safe. 2 Palliative care consultations involving discussions about patient goals and values, which are recommended by the National Institute of Health when caring for persons with COVID-19, 24 may help mitigate racial disparities 20,25 associated with serious illnesses such as COVID-19. Researchers have found Black patients are as likely as White patients to engage in goals-of-care conversations when led by trained palliative care clinicians.…”

“…Researchers have found Black patients are as likely as White patients to engage in goals-of-care conversations when led by trained palliative care clinicians. 20,25 Primary palliative care and hospital-based palliative care teams trained in serious illness communication support patient decision-making by providing empathic communication and culturally sensitive information sharing. The palliative care approach, which emphasizes listening to patient values and goals and clarifying prognosis and care options in addition to meeting physical needs, benefits patients and families across races.…”

“…Studies of home-based palliative care and inpatient palliative care have demonstrated favorable outcomes for Black Americans with serious illness, including increased satisfaction, increased documentation of treatment preferences, and higher rates of home death and hospice referrals. 20,21 Recent research shows, for example, that seriously ill Black patients who had a goals-of-care consultation were 15 times more likely to choose hospice than demographically and clinically similar, propensity score-matched Black patients without a consultation. 18 Evidence also shows seriously ill Black patients live longer when they receive palliative care consultation.…”