Racial Disparities in End-of-Life Planning and Services for Deceased Nursing Home Residents

Frahm, Kathryn A.; Brown, Lisa M.; Hyer, Kathryn

doi:10.1016/j.jamda.2012.07.021

Cited by 33 publications

(33 citation statements)

References 36 publications

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“…Studies suggest that racial and socioeconomic factors hinder appropriate utilization of palliative care and hospice. [12–15] When compared to white patients, minorities from lower socioeconomic groups experience reduced rates of advance directive formation, increased likelihood of being hospitalized in their final 90 days of life, increased ICU admissions, increased ER visits and decreased likelihood of hospice enrollment at the end of life. [12–14]…”

Section: Introductionmentioning

confidence: 99%

Dying well: How equal is end of life care among gynecologic oncology patients?

Taylor

Brown

Prescott

et al. 2016

Gynecologic Oncology

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Objective To identify disparities in utilization of end of life (EoL) resources by gynecologic oncology (GO) patients. Methods This retrospective analysis of the medical records of GO patients treated 1/2007–12/2011 and deceased 1/2012 – 8/2014 evaluated patient demographics, disease characteristics, and utilization of EoL resources. Chi-square, Fisher’s exact test, Mann Whitney and Kruskal-Wallis tests were used for statistical analysis. Results Of 189 patients analyzed, 113 (60%) were white, 38 (20%) Hispanic, 31 (16%) black, and seven (4%) Asian. Ninety-five (48%) had ovarian cancer, 51 (26%) uterine, 47 (23%) cervical, seven (3%) vulvar/vaginal. In the last 30 days of life (DoL), 18 (10%) had multiple hospital admissions, 10 (5%) admitted to the Intensive Care Unit (ICU), 30 (16%) multiple Emergency Room (ER) visits, 45 (24%) received aggressive medical care and eight (4%) received chemotherapy in the final 14 DoL. Furthermore, 54 (29%) had no Supportive Care referral and 29 (15%) no hospice referral. Only 46 (24%) had a Medical Power of Attorney (PoA) or Living Will (LW) on file. Non-white race was associated with increased odds of dying without hospice (OR 3.07; 95%CI [1.27, 2.46], p=0.013). However, non-white patients who enrolled in hospice did so earlier than white patients (42 v. 27 days before death, p=0.054). Non-white patients were also significantly less likely to have PoA/LW documentation (24% v. 76%, p=0.009) even if enrolled in hospice (12% v. 31%, p=0.007). Conclusions Significant racial disparities in hospice enrollment and PoA/LW documentation were seen in GO patients. This warrants further study to identify barriers to use of EoL resources.

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Section: Introductionmentioning

confidence: 99%

Dying well: How equal is end of life care among gynecologic oncology patients?

Taylor

Brown

Prescott

et al. 2016

Gynecologic Oncology

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“…At the resident level, we found that burdensome EOL transitions were more common in nonwhites and those with multiple comorbidities. Racial disparities in EOL care are well described . Although the association between functional impairment and health care utilization is a well‐described phenomenon in community dwellers with and without cancer and in NH residents with curable cancers, we found that coexisting functional impairment and advanced cancer were associated with increased odds of burdensome EOL transitions.…”

Section: Discussionmentioning

confidence: 56%

Potentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancer

Lage

DuMontier

Lee

et al. 2019

Cancer

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Background This study examined factors associated with potentially burdensome end‐of‐life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). Methods A retrospective analysis of deceased older NH residents with poor‐prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. Results Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do‐not‐resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. Conclusions NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.

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“…This finding may be indicative of differential information needs by these two racial subgroups. Consistently, studies have reported lower rates of care‐limiting advance directives among black older adults compared to white older adults . One possible explanation for this disparity is that black patients are not offered optimal counseling and given the information necessary to make an informed choice .…”

Section: Discussionmentioning

confidence: 96%

Black Nursing Home Residents More Likely to Watch Advance Care Planning Video

Loomer

Volandes

Mitchell

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES This study aims to identify resident characteristics associated with being offered and subsequently shown an advance care planning (ACP) video in the Pragmatic Trial of Video Education in Nursing Homes (PROVEN) and if differences are driven by within‐ and/or between‐facility differences. DESIGN Cross‐sectional study, from March 1, 2016, to May 31, 2018. SETTING A total of 119 PROVEN intervention nursing homes (NHs). PARTICIPANTS A total of 43 303 new NH admissions. MEASUREMENTS Data came from the Minimum Data Set and an electronic record documenting whether a video was offered and shown to residents. We conduct both naïve logistic regression models and hierarchical logistic models, controlling for NH fixed effects, to examine the overall differences in offer and show rate by resident characteristics. RESULTS In naïve regression models, compared to white residents, black residents are 7.8 percentage point (pp) (95% confidence interval [CI] = −9.1 to −6.5 pp) less likely to be offered the video. These differences decrease to 1.3 pp (95% CI = −2.61 to −0.02 pp) when accounting for NH fixed effects. In fully adjusted models, black residents compared to white residents were 2.1 pp more likely to watch the video contingent on being offered (95% CI = 0.4‐3.7 pp). Residents with cognitive impairment were less likely to be offered and shown the video. CONCLUSIONS After controlling for NH fixed effects, there were smaller racial differences in being offered the video, but once offered, black residents were more likely to watch the video. This suggests that black residents are receptive to this type of ACP intervention but need to be given an opportunity to be exposed. J Am Geriatr Soc 68:603–608, 2020

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Racial Disparities in End-of-Life Planning and Services for Deceased Nursing Home Residents

Cited by 33 publications

References 36 publications

Dying well: How equal is end of life care among gynecologic oncology patients?

Dying well: How equal is end of life care among gynecologic oncology patients?

Potentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancer

Black Nursing Home Residents More Likely to Watch Advance Care Planning Video

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