Trends and Racial Disparities of Palliative Care Use among Hospitalized Patients with ESKD on Dialysis

Wen, Yumeng; Jiang, Changchuan; Koncicki, Holly M.; Horowitz, Carol R.; Cooper, Richard S.; Saha, Aparna; Coca, Steven G.; Nadkarni, Girish N.; Chan, Lili

doi:10.1681/asn.2018121256

Cited by 45 publications

(48 citation statements)

References 49 publications

(64 reference statements)

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“…Supported by existing literature, racial minority groups consistently report low educational literacy regarding palliative care, hospice care, and advance care planning, which leads to lower levels of engagement in advance care planning and discussions with health care providers. 1,15,16 Additionally, minorities are more likely than non-Hispanic Whites to receive palliative care services 17 and report less satisfying outcomes when completing an advanced directive. 15 It should be acknowledged that racial disparities may be a major contributor in the access and completion of advance directives, and knowledge and awareness deficits.…”

Section: Discussionmentioning

confidence: 99%

Awareness of Palliative Care, Hospice Care, and Advance Directives in a Racially and Ethnically Diverse Sample of California Adults

Bazargan

Cobb

Assari

et al. 2021

Am J Hosp Palliat Care

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Background: Numerous studies have documented multilevel racial inequalities in health care utilization, medical treatment, and quality of care in minority populations in the United States. Palliative care for people with serious illness and hospice services for people approaching the end of life are no exception. It is also well established that Hispanics and non-Hispanic Blacks are more likely than non-Hispanic Whites to have less knowledge about advance care planning and directives, hospice, and palliative care. Both qualitative and quantitative research has identified lack of awareness of palliative and hospice services as one of the major factors contributing to the underuse of these services by minority populations. However, an insufficient number of racial/ethnic comparative studies have been conducted to examine associations among various independent factors in relation to awareness of end-of-life, palliative care and advance care planning and directives. Aims: The main objective of this analysis was to examine correlates of awareness of palliative, hospice care and advance directives in a racially and ethnically diverse large sample of California adults. Methods: This cross-sectional study includes 2,328 adults: Hispanics (31%); non-Hispanic Blacks (30%); and non-Hispanic Whites (39%) from the Survey of California Adults on Serious Illness and End-of-Life 2019. Using multivariate analysis, we adjusted for demographic and socio-economic variables while estimating the potential independent impact of health status, lack of primary care providers, and recent experiences of participants with a family member with serious illnesses. Results: Hispanic and non-Hispanic Black participants are far less likely to report that they have heard about palliative and hospice care and advance directives than their non-Hispanic White counterparts. In this study, 75%, 74%, and 49% of Hispanics, non-Hispanic Blacks, and non-Hispanic White participants, respectively, claimed that they have never heard about palliative care. Multivariate analysis of data show gender, age, education, and income all significantly were associated with awareness. Furthermore, being engaged with decision making for a loved one with serious illnesses and having a primary care provider were associated with awareness of palliative care and advance directives. Discussion: Our findings reveal that lack of awareness of hospice and palliative care and advance directives among California adults is largely influenced by race and ethnicity. In addition, demographic and socio-economic variables, health status, access to primary care providers, and having informal care giving experience were all independently associated with awareness of advance directives and palliative and hospice care. These effects are complex, which may be attributed to various historical, social, and cultural mechanisms at the individual, community, and organizational levels. A large number of factors should be addressed in order to increase knowledge and awareness of end-of-life and palliative care as well as completion of advance directives and planning. The results of this study may guide the design of multi-level community and theoretically-based awareness and training models that enhance awareness of palliative care, hospice care, and advance directives among minority populations.

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Section: Discussionmentioning

confidence: 99%

Awareness of Palliative Care, Hospice Care, and Advance Directives in a Racially and Ethnically Diverse Sample of California Adults

Bazargan

Cobb

Assari

et al. 2021

Am J Hosp Palliat Care

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“…After searching almost fourthly-thousand citations, 284 articles were included in our study, of which 147 were manuscripts that directly addressed end-of-life and hospice care, palliative care, as well as advance care planning and directives that include non-Hispanic Blacks. 4 …”

Section: Methodsmentioning

confidence: 99%

“…Overwhelming evidence, based on large national data sets, consistently and unequivocally points to major disparities in palliative care in the United States. 13 , 39 , 40 , 55 , 64 One retrospective cohort study of over 5 million hospitalizations of dialysis patients revealed that non-Hispanic Black and Hispanic patients were less likely than non-Hispanic White patients to receive palliative care services in the hospital. This disparity was observed in all hospital subtypes, even hospitals with a high proportion of minority patients.…”

Section: Methodsmentioning

confidence: 99%

“…This disparity was observed in all hospital subtypes, even hospitals with a high proportion of minority patients. 13 Similarly, the Nationwide Inpatient Sample, which included 46,735 intracerebral hemorrhage and 331,521 ischemic stroke inpatient hospital admissions between 2007 and 2011, revealed that patients receiving care in minority hospitals had lower odds of palliative care compared to those treated in hospitals that served mostly non-Hispanic White patients. Ethnic minorities had a lower likelihood of receiving palliative care compared to whites in any hospital stratum, suggesting system-level factors in racial disparities in palliative care use after stroke.…”

Section: Methodsmentioning

confidence: 99%

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Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Bazargan

Bazargan‐Hejazi

2020

Am J Hosp Palliat Care

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Objectives: Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. Methods: The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. Discussion: Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.

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“…2 Further, many a researcher has built an academic career pointing out these disparities, without ever suggesting real ways to overcome them. In this issue of JASN, Wen et al 3 provide us with yet another example.…”

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confidence: 99%

Another Example of Race Disparities in the US Healthcare System

Grubbs

2019

JASN

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Trends and Racial Disparities of Palliative Care Use among Hospitalized Patients with ESKD on Dialysis

Cited by 45 publications

References 49 publications

Awareness of Palliative Care, Hospice Care, and Advance Directives in a Racially and Ethnically Diverse Sample of California Adults

Awareness of Palliative Care, Hospice Care, and Advance Directives in a Racially and Ethnically Diverse Sample of California Adults

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

Another Example of Race Disparities in the US Healthcare System

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