Lack of Ethnic Differences in End-of-Life Care in the Veterans Health Administration

Abstract

Although existing literature shows pervasive ethnic disparities in end-of-life care, this study sought to determine if there were ethnic differences in the processes of care related to the end of life in a cohort of hospitalized, seriously ill veterans. The medical records of 217 patients (13% African American, 68% white, 9% Hispanic White) were reviewed for documentation of end-of-life care (advance directive discussions, pain, symptom-directed plan, and do-not-resuscitate orders). Logistic regression modeling demonstrated no ethnic differences for the treatment of pain or a symptom-directed plan of care. African American patients were more likely to have a do-not-resuscitate order and advance directive discussion documented compared with white patients. In this equal access system, minority patients were at least as likely or more likely to have important aspects of end-of-life care addressed compared with white patients.

Pain and symptom management in palliative care and at end of life

“…However, evidence on racial/ethnic disparities in pain and symptom assessment and management at the end of life is scarce. Available evidence shows: (1) no racial/ethnic disparities in the use of high-intensity medication (prescribed to treat moderate to severe pain) in women deceased from ovarian cancer (Rolnick et al, 2007); (2) pain treatment did not differ for Caucasian and minorities (African American and Hispanic) veteran patients hospitalized for end-of-life care (Fischer et al, 2007); and (3) no difference in pain location, intensity, quality or pattern or in the use of pain medication between African American and Caucasian cancer patients receiving care from a hospice/palliative care program (Stapleton, 2010). The results are consistent but contrary to reports of pervasive racial and ethnic disparities in pain management of patients who are not facing the end of their lives (Cintron & Morrison, 2006; Ezenwa, Ameringer, Ward, & Serlin, 2006; Meghani, Byun, & Gallagher, 2012).…”

A Call to Improve Practice Concerning Cultural Sensitivity in Advance Directives: A Review of the Literature

“…The intervention included education of patients and providers. Fischer and colleagues (2007) did a retrospective chart review to evaluate the effect of ethnicity on do not resuscitate orders and use of AD in hospitalized veterans. They used logistic regression to study AD discussions between African Americans, European Americans, and Hispanic Americans.…”

“…Three distinct themes emerged in the evidence. The first theme was related to ACP and AD and established that ADs should be culturally sensitive in order to meet the needs for end‐of‐life planning in this era of increased globalization (Kiely et al 2001; Pearlman et al 2005; Fisher et al 2007; Sudore et al 2007; Abbo et al 2008) (see Table 8). Two studies were found that focused on the design of AD (Sudore et al 2007; Abbo et al 2008).…”

Gaps in Provision of Primary and Specialty Palliative Care in the Acute Care Setting by Race and Ethnicity

“…One small chart review study at a Veterans Affairs Hospital showed similar rates of advance care planning by primary teams across racial and ethnic groups. 19 Based on this literature, we hypothesized that rates of palliative care consultation and primary palliative care would be similar across racial and ethnic groups. This study aimed to estimate primary and specialty palliative care delivery in the inpatient setting and to explore racial and ethnic differences in palliative care delivery.…”