Intensity of End-of-Life Care for Patients with Hematologic Malignancies and the Role of Race/Ethnicity

Kirtane, Kedar; Downey, Lois; Lee, Stephanie J.; Curtis, J. Randall; Engelberg, Ruth A.

doi:10.1089/jpm.2018.0152

Cited by 28 publications

(31 citation statements)

References 30 publications

(28 reference statements)

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“…The finding of more aggressive end-of-life care among decedents of Chinese or South Asian ethnicity is similar to the findings of other large-scale quantitative analyses assessing end-of-life care for people from ethnic minorities in North America such as Hispanic or black people. 16,44,45 Although each ethnic group has multiple unique underlying contributors to these findings, some factors such as provider-patient ethnicity discordance, decreased socioeconomic resources and discrimination may be common to different minority ethnicities. 5,46,47 We found contrasting results with respect to receipt of palliative care in the final 6 months of life, with decedents of South Asian ethnicity less likely, and decedents of Chinese ethnicity more likely, to receive palliative care relative to decedents from the general population.…”

Section: Discussionmentioning

confidence: 99%

Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada

Yarnell

Bonares

et al. 2020

CMAJ

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C ulturally appropriate, patient-focused end-of-life care is an essential component of health care. Despite a preference to die at home, most Canadians die in hospitals and many receive end-of-life care in intensive care units (ICUs). 1-3 Multiple factors contribute to this discrepancy, including uncertainty about the imminence of death, challenges in communication between health care teams and patients and families, poor health literacy and lack of access to palliative care resources. 3-7 These factors may be more pronounced among people from minority ethnic groups. Differences in preferences for intervention at the end of life among ethnic groups may also influence care; the research showing a preference for dying at home included mostly white Canadians. 1 People of Chinese and South Asian ethnicity are the most rapidly growing ethnic groups in Canada, yet little is known about their end-of-life care. 8,9 Comparative studies from the United States have focused on black and Hispanic Americans 8-13 and suggest that minority ethnicity is associated with lower family-rated quality of end-of-life care, 14 increased use of life-support technologies, 13 and decreased use of advanced directives or hospice. 6,12,15-17 Qualitative research describing end-of-life care for people of Chinese or South Asian ethnicities in international settings shows some common themes, including reluctance to share terminal diagnoses, emphasis on collective as opposed to individual decision-making, and attenuation of differences with acculturation. 6,18,19 For people of Chinese ethnicity, research highlights the influence of Confucian philosophy and the role of children in decisions regarding elderly parents. 20-23 For people of South Asian ethnicity, research emphasizes notions of karma, ambivalence toward the cultural appropriateness of hospices or sedating analgesic

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Section: Discussionmentioning

confidence: 99%

Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada

Yarnell

Bonares

et al. 2020

CMAJ

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“…7 Retrospective cohort study (2010)(2011)(2012)(2013)(2014)(2015) of hospital utilization among racial/ethnic minority patients with hematologic and non-hematologic malignancies suggested that racial/ethnic minority patients with hematologic malignancies have higher utilization of care at the end of life and lower rates of advance directives compared with non-Hispanic patients. 49 Delay of initiation of outpatient palliative care consultation among non-Hispanic Black cancer patients also highlights a racial disparity. 53 Ahluwalia and colleagues (2018) examined 139 systematic reviews published after 2013, when the third edition of National Consensus Project Clinical Practice Guidelines for Quality Palliative Care was published.…”

Section: Methodsmentioning

confidence: 99%

“…175 Existing data clearly show that the odds of delayed hospice referral near the end of life were greater in non-Hispanic Blacks than in non-Hispanic Whites. 49 The disparity in hospice use among ethnic minority populations is a complex and nuanced problem, involving numerous interrelated barriers. 41 A systematic review of both qualitative and quantitative research identified factors that contribute to the underuse of hospice services by non-Hispanic Blacks.…”

Section: Methodsmentioning

confidence: 99%

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Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Bazargan

Bazargan‐Hejazi

2020

Am J Hosp Palliat Care

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Objectives: Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. Methods: The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. Discussion: Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.

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“…There is some debate about whether the use of chemotherapy near death represents a reliable marker of aggressiveness of care in this population, given the fact that anticancer treatment may be appropriate for some patients with HM. 14,15 Indeed, hematologic specialists reported to feel more comfortable to prescribe systemic therapy to patients with poor performance status in the last month of life than solid tumor specialists. 16 In the acute care setting, clinical complications and relapses in HM are usually better investigated with medical imaging, which helps explain why the majority of patients in this study had undergone CT scans and MRI examinations prior to death.…”

Section: Discussionmentioning

confidence: 99%

Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil

Soares¹,

Gomes²,

Japiassú

2019

Am J Hosp Palliat Care

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Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; P < .001), to receive blood transfusions (57% vs 38%; P = .05), and to die in the hospital (76% vs 39%; P = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital.

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Intensity of End-of-Life Care for Patients with Hematologic Malignancies and the Role of Race/Ethnicity

Abstract: Our findings suggest that racial/ethnic minority patients with HM have higher utilization of care at the end-of-life and lower rates of advance directives compared with NHW patients.

Cited by 28 publications

References 30 publications

Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada

Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil

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