Barriers to Optimum End‐of‐life Care for Minority Patients

Abstract

Although major efforts are underway to improve end-of-life care, there is growing evidence that improvements are not being experienced by those at particularly high risk for inadequate care: minority patients. Ethnic disparities in access to end-of-life care have been found that reflect disparities in access to many other kinds of care. Additional barriers to optimum end-of-life care for minority patients include insensitivity to cultural differences in attitudes toward death and end-of-life care and understandable mistrust of the healthcare system due to the history of racism in medicine. These barriers can be categorized as institutional, cultural, and individual. Efforts to better understand and remove each type of barrier are needed. Such efforts should include quality assurance programs to better assess inequalities in access to end-of-life care, political action to address inadequate health insurance and access to medical school for minorities, and undergraduate and continuing medical education in cultural sensitivity.

Racial and Ethnic Differences in Advance Care Planning Among Patients With Cancer: Impact of Terminal Illness Acknowledgment, Religiousness, and Treatment Preferences

“…20,34,35 Nevertheless, we did not find support for religiousness as a mediator of racial/ethnic differences in ACP. Several possible explanations exist.…”

Diversities in approach to end-of-life: A view from Britain of the qualitative literature

“…The paper that, in the estimation of this reviewer, holds the most promise for interpolation into policy and practice in the UK, is one written by three US MDs, Krakauer, Crenner and Fox (Krakauer et al 2002). Reviewing over 150 papers, the authors avoid the pitfalls of becoming bogged down in the review process itself and provide thoughtful discussion on the barriers to optimum end-of-life care for minority patients.…”

“…In their study on barriers to optimum end-of-life care for minority patients, Krakauer et al (2002) point to the fact that African Americans prefer aggressive life-sustaining treatment more often than European Americans. The authors discuss issues of mistrust and medical racism, elaborated in their review, as contributing factors.…”

Patients' diverse beliefs about what happens at the time of death

“…5 Prior studies showing ethnic cultural differences over advance care planning, life support, and other aspects of dying further supported our assumption. 3,8,[10][11][12] Our interview study revealed occasional beliefs that may characterize Americans in general, some beliefs that may characterize only certain ethnic groups or genders, and many beliefs that may characterize only particular individuals.…”

“…We assumed that culture-the values a group uses to interpret shared experiences and transmits across generations 2,3 -influences those beliefs. 1,[4][5][6][7][8][9][10] We reasoned that, because death is a universal human experience, every culture must address its meaning. 5 Prior studies showing ethnic cultural differences over advance care planning, life support, and other aspects of dying further supported our assumption.…”