The Influence of Race on End-of-Life Choices Following a Counselor-Based Palliative Consultation

Abstract

Black Americans are more likely than whites to choose aggressive medical care at the end of life. We present a retrospective cohort study of 2843 patients who received a counselor-based palliative care consultation at a large US southeastern hospital. Before the palliative consultation, 72.8% of the patients had no restrictions in care, and only 4.6% had chosen care and comfort only (CCO). After the consult, these choices dramatically changed, with only 17.5% remaining full code and 43.3% choosing CCO. Both before and after palliative consultation, blacks chose more aggressive medical care than whites, but racial differences diminished after the counselor-based consultation. Both African American and white patients and families receiving a counselor-based palliative consultation in the hospital make profound changes in their preferences for life-sustaining treatments.

Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer

“…In particular, racial/ethnic disparities both in receipt of aggressive care and hospice use have been documented extensively. Indeed, compared to others, minority patients are more likely to choose aggressive care [19] or to be hospitalized after being enrolled in hospice [20], and less likely to enroll in hospice care [17,21–24]. However, seldom have previous studies examined disparities in the specific context of geriatric patients with cancer presenting with multimorbidity (MM), defined here as the co-occurrence of not only chronic conditions but also functional limitations and geriatric syndromes [25].…”

Interdisciplinary palliative care teams : insights and experiences of chaplain interns and social work interns.

“…The percentage of African American patients who chose full code dropped from 78.8% to 22.2%, and on the same measure, White patients dropped from 67.3% to 12.2% after the palliative consultation. These findings suggest the comprehensive counselor-based palliative care consultation for hospitalized patients was correlated with both White and African American patients choosing end-of-life care choices with fewer life-sustaining interventions (Benton et al, 2015).…”

“…Race proved to be an important factor in treatment choices, with both groups (i.e., White patients and African American patients) moving from more aggressive treatments to less aggressive treatments after palliative care consultation (Benton et al, 2015). The percentage of African American patients who chose full code dropped from 78.8% to 22.2%, and on the same measure, White patients dropped from 67.3% to 12.2% after the palliative consultation.…”

“…A retrospective study of 2,843 White and African American patients' treatment choices before and after receiving a standardized counselor-based palliative care consultation were reviewed. Benton et al (2015) (Benton et al, 2015).…”

“…One empirical study from this counselor-based palliative care program researched the influence of race on end-of-life choices (Benton et al, 2015). A retrospective study of 2,843 White and African American patients' treatment choices before and after receiving a standardized counselor-based palliative care consultation were reviewed.…”