Racial Disparities in Receipt of Hospice Services Among Nursing Home Residents

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

doi:10.1177/1049909113511144

Cited by 20 publications

(19 citation statements)

References 32 publications

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“…However, disparities still exist among ovarian cancer patients with regard to hospice usage and receiving invasive end of life care [11][12][13][14]. Ovarian cancer patients of minority race and ethnicity and those of lower socioeconomic status have less hospice use and more aggressive end of life care, similar to patterns seen in other disease sites [15,16].…”

Section: Introductionmentioning

confidence: 94%

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

Taylor

Zhang

Rajan³

et al. 2019

Gynecologic Oncology

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To describe disparities in patterns of hospice use and end-of-life costs among ovarian cancer patients. Methods. Using Texas Cancer Registry-Medicare data, ovarian cancer patients deceased 2005-2012 with N12 months of continuous Medicare coverage before death were included. Descriptive statistics and multivariable logistic regressions were used to evaluate patterns of hospice use. Cost and resource utilization was obtained from Medicare claims and analyzed using a non-parametric Mann-Whitney test. Results. 2331 patients were assessed: 1788 (77%) white, 359 (15%) Hispanic, 158 (7%) black and 26 (1%) other. 1756 (75%) enrolled in hospice prior to death but only 1580 (68%) died with hospice. 176 (10%) of 1756 patients unenrolled and died without hospice. 346 (20%) unenrolled from hospice multiple times. From 2008 to 2012, patients were less likely to unenroll from hospice prior to death. Black patients were more likely to unenroll from hospice prior to death (OR 2.07 [1.15-3.73]; p = 0.02) compared to white patients. The median amount paid by Medicare during the last six months of life was $38,530 for those in hospice compared to $49,942 if never enrolled in hospice (p b 0.0001) and was higher for black and Hispanic patients compared to white patients. 30% hospice unenrolled patients and 40% multiply enrolled hospice patients received at least one life extending or invasive care procedure following unenrollment from hospice. Conclusion. Recently, more patients remain enrolled in hospice, but black patients have a higher risk of unenrollment. Hospice enrollment was associated with lower costs as long as a patient did not unenroll from hospice.

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Section: Introductionmentioning

confidence: 94%

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

Taylor

Zhang

Rajan³

et al. 2019

Gynecologic Oncology

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“…Research suggests that multiple factors, such as family dynamics as well as interactions among patients, family members, and health care providers affect EOL decision making among AAs (Smith-Howell, Hickman, Meghani, Perkins, & Rawl, 2016). Similarly, hospice and palliative care as ACP options are used less by AAs than WAs (Frahm, Brown, & Hyer, 2015; Lovell & Yates, 2014).…”

Section: Introductionmentioning

confidence: 99%

Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature

et al. 2018

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Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are affected by demographic variables, cultural distinctives related to patient autonomy, mistrust of the health care system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. An integrative review was conducted to synthesize nursing knowledge regarding cultural perspectives of end-of-life and advance care planning among African Americans. Twenty-four articles were reviewed. Nurses educate patients and families about end-of-life planning as mandated by the Patient Self-Determination Act of 1991. Implementation of advance directives promote patient and family centered care, and should be encouraged. Clinicians must be sensitive and respectful of values and practices of patients of diverse cultures, and initiate conversations with open-ended questions facilitating patient trust and sharing within the context of complex beliefs, traditions, and lifeways.

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“…As one example, black and Hispanic Americans are less likely than white Americans to have healthcare advance directives. [2][3][4][5][6][7] As advance directives can be important tools for protecting patient autonomy and reducing distress among surrogate decision-makers, 1,8 these racial and ethnic differences may represent important disparities in quality health care at the end of life. However, the causes of these racial and ethnic differences are poorly understood, and therefore potential targets for interventions to improve advance care planning in these populations are not well characterized.…”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

Huang

Neuhaus

Chiong

2016

Journal of Palliative Medicine

102

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Background: Black and Hispanic older Americans are less likely than white older Americans to possess advance directives. Understanding the reasons for this racial and ethnic difference is necessary to identify targets for future interventions to improve advance care planning in these populations. Methods: The aim of the study was to evaluate whether racial and ethnic differences in advance directive possession are explained by other demographic factors, religious characteristics, and personal health values. A general population survey was conducted in a nationally representative sample using a web-enabled survey panel of American adults aged 50 and older (n = 2154). Results: In a sample of older Americans, white participants are significantly more likely to possess advance directives (44.0%) than black older Americans (24.0%, p < 0.001) and Hispanic older Americans (29.0%, p = 0.006). Gender, age, retired or disabled employment status, educational attainment, religious affiliation, Internet access, preferences for physician-centered decision making, and desiring longevity regardless of functional status were independent predictors of advance directive possession. In fully adjusted multivariable models with all predictors included, black older Americans remained significantly less likely than white older Americans to have an advance directive (odds ratio [OR] = 0.42, 95% confidence interval [CI] = 0.24-0.75), whereas the effect of Hispanic ethnicity was no longer statistically significant (OR = 0.65, 95% CI = 0.39-1.1). Conclusion: In a nationally representative sample, black race is an independent predictor for advance directive possession. This association remains even after adjustment for other demographic variables, religious characteristics, and personal health values. These findings support targeted efforts to mitigate racial disparities in access to advance care planning.

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Racial Disparities in Receipt of Hospice Services Among Nursing Home Residents

Cited by 20 publications

References 32 publications

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

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