Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer

Ingersoll, Luke T; Alexander, Stewart C.; Priest, Jeff S.; Ladwig, Susan; Anderson, Wendy G.; Fiscella, Kevin; Epstein, Ronald M.; Norton, Sally A.; Gramling, Robert

doi:10.1016/j.pec.2019.01.002

Cited by 34 publications

(25 citation statements)

References 36 publications

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“…The emphasis on cross cultural communication skills is noteworthy since there is substantial evidence of disparities in communication outcomes for racial and ethnic minorities with serious illness. [30][31][32][33] Less than 60% of hospices reported covering disparities in EOL care or disparities in healthcare in general as recommended by the National CLAS standards. Such content may provide context for importance of CC although there is no evidence that this content changes impact or outcomes of training.…”

Section: Discussionmentioning

confidence: 99%

Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?

Boucher

Johnson

2020

Am J Hosp Palliat Care

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Background: Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities. Objective: To describe the state of CC training across hospices. Design: National survey of hospices’ practices to promote CC. Results: A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were: cross-cultural communication, death/illness beliefs, spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)—the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT. Conclusions: CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.

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Section: Discussionmentioning

confidence: 99%

Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?

Boucher

Johnson

2020

Am J Hosp Palliat Care

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“…Nevertheless, little is known about the effectiveness of communicating this kind of information in the oncologist's office in a situation in which the effect of recent cancer surgery and emotional stress affect the ability to comprehend the language being used, thereby casting doubt on the validity of this SDM between patient and oncologist as to the advisability of receiving adjuvant treatment, its benefits, and risks. Furthermore, several factors influence how the patient participates in SDM (Street et al, 1995;Bakker et al, 2001;Janz et al, 2004;Maly et al, 2004;Ingersoll et al, 2019). Low-educated and older patients are often associated with a passive role (Street et al, 1995), with education being more consistent than age as a factor impinging on patient-physician communication (Janz et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, doctors may provide less informative to individuals with lower levels of education (high school or less) and lower incomes (Bakker et al, 2001). As for race, fewer consultations for information concerning prognosis have been reported in the black and Latino populations, as well as unrealistic optimism regarding this prognosis (Ingersoll et al, 2019). In North American studies, ethnic minority women (i.e., African American and Latino breast cancer patients) were considerably less likely than white patients to perceive themselves as the chief treatment decision-makers, while at the same time, they were more likely to question their physician about their treatment, possibly due to mistrust of the healthcare system (Maly et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Estimation of Risk of Recurrence and Toxicity Among Oncologists and Patients With Resected Breast Cancer: A Quantitative Study

et al. 2020

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Shared decision-making regarding adjuvant systemic therapy in breast cancer is based on both properly conveying information about the prognosis of the disease and the benefits and risks of adjuvant treatment, as well as the patient's ability to understand this information. This work proposed to analyze oncologists' and patients' perceptions of the risk of recurrence with and without chemotherapy and toxicity, and the factors influencing said impressions. This was a prospective, crosssectional, multicenter study that involved 281 breast cancer patients and 23 oncologists. Prognosis (risk of recurrence with and without chemotherapy and risk of severe toxicity with chemotherapy) and shared decision making (SDM) questionnaires were completed by all participants; breast cancer patients also filled out the 18-item Brief Symptom Inventory (BSI-18). Oncologists' prediction of risk of relapse without and with chemotherapy (30.4 and 13.3%) and risk of severe toxicity (9.8%) were more optimistic than those of breast cancer patients (78.6, 29.6, and 61%, respectively). The greater the severity, the higher the risk of relapse according to the oncologists (p = 0.001); not so for the patients. Older physicians and more experienced ones predicted lower risk of relapse with and without chemotherapy and less severe toxicity than younger doctors and those with less experience (p < 0.001). Oncologists' SDM and their prediction of risk of relapsing with chemotherapy correlated negatively with patients' SDM and their prediction of risk of severe toxicity (p < 0.01). There is a positive correlation between psychological distress (BSI-18) and prognosis of risk of recurrence with chemotherapy in breast cancer patients (p < 0.001). These results stress the importance of improving doctor-patient communication in SDM. In breast cancer patients undergoing treatment with curative intent, expectations of being cured would increase and treatment-related anxiety would decrease by enhancing doctor-patient communication to coincide more with respect to risk of relapse and toxicity, thereby enhancing patients' quality of life.

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“…10 When these discussions occur, prognostic information is given less often to black patients. 11 This is problematic because discussions including information on expected length of life have been shown to be critical to facilitating hospice enrollment. 12 Overall, communication has been shown to be less effective in ensuring goal-concordant care for black patients compared with whites.…”

Section: Introductionmentioning

confidence: 99%

Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit

Chuang

Fiter

Sanon

et al. 2020

Am J Hosp Palliat Care

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Purpose: Racial and ethnic minority patients receive poorer quality end-of-life (EoL) care compared with white patients. Differences in quality of communication (QOC) with clinicians may contribute to these disparities. We measured differences in satisfaction with communication in the intensive care unit (ICU) by race and ethnicity. Materials and Methods: This is a cross-sectional survey of family members of patients in ICUs of an academic medical center serving a diverse urban population using The Family Satisfaction with the ICU (FS-ICU) and QOC scales. Results: One hundred surveys were completed (18.8% white, non-Hispanic; 34.4% black, non-Hispanic; 31.3% Hispanic; 15.6% other race/ethnicity). Mean FS-ICU score was 84.2 (standard deviation [SD] 20.5) for white patients, 83.3 (SD 16.2) for black patients, 82.7 (SD 17.8) for Hispanic or Latino patients, and 80.9 (SD 18.8) for patients with other race/ethnicity (Kruskal-Wallis, P = .92). Differences remained insignificant when controlling for patient and respondent characteristics. The QOC scale was not scored due to nonresponse levels on questions about EoL communication. Conclusions: Uniformly high ratings may have been influenced by avoidance of EoL discussion. This study is inconclusive regarding whether QOC influences disparities in EoL care since quality of EoL communication was not captured.

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Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer

Cited by 34 publications

References 36 publications

Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?

Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?

Estimation of Risk of Recurrence and Toxicity Among Oncologists and Patients With Resected Breast Cancer: A Quantitative Study

Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit

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