End-of-Life Care for People With Cancer From Ethnic Minority Groups

LoPresti, Melissa A.; Dement, Fritz; Gold, Heather T.

doi:10.1177/1049909114565658

Cited by 189 publications

(182 citation statements)

References 35 publications

(206 reference statements)

Supporting

Mentioning

175

Contrasting

Unclassified

Order By: Relevance

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Koroukian

Schiltz

Warner

et al. 2017

Journal of Geriatric Oncology

View full text Add to dashboard Cite

Objective Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care. Methods From the linked 1991–2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66 years who died from cancer (n = 835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders. Results While 61.2% of the patients enrolled in hospice, 24.6% underwent cancer-directed treatment; 55.1% were admitted to the hospital and/or ED; and 21.7% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others. Conclusions To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Koroukian

Schiltz

Warner

et al. 2017

Journal of Geriatric Oncology

View full text Add to dashboard Cite

show abstract

“…In their review on contextual factors influencing ACP uptake in palliative care, Lovell and Yates concluded that factors influencing the uptake of ACP are "complex and multifaceted, reflecting the diverse and often competing needs of patients, health professionals, legislature, and health systems" (Lovell & Yates, 2014). Indeed, several papers and reviews have looked at the many barriers to the implementation of ACP, for example cultural aspects, timing of ACP discussions, sometimes in relation to specific medical conditions (Fritz et al, 2016), shifts in preferences over time, and the attitudes and beliefs of healthcare providers (Auriemma et al, 2014;Lopresti, Dement, & Gold, 2016;Lovell & Yates, 2014) reiterating the complexity of the ACP process.…”

mentioning

confidence: 99%

Factors influencing the engagement of cancer patients with advance care planning: A scoping review

et al. 2019

View full text Add to dashboard Cite

Introduction Advance care planning (ACP) is increasingly regarded as the best way to optimise end‐of‐life (EOL) care. Studies have examined a multitude of factors impacting on the lagging uptake of ACP. In the current study, we specifically focused on patient factors related to the uptake of ACP in adult cancer patients. Methods A scoping review was conducted, for which we searched the CINAHL, Cochrane, MEDLINE and PsycINFO databases (January 2013–December 2018). Studies exploring patient‐related factors influencing the uptake of ACP in cancer patients were eligible for inclusion. Results Eleven papers and two overarching themes: person‐related (e.g. socio‐demographic) factors and “comprehension and awareness,” were identified. White, well‐educated patients with a support network were more likely to be involved in ACP. However, there is limited comprehension and awareness among cancer patients regarding ACP. Conclusions The identified themes warrant a tailored approach to ACP. With regard to person‐related factors, the existing body of knowledge on health literacy, disparities and shared decision‐making should be used when designing strategies to improve ACP uptake. Further, our findings regarding “comprehension and awareness” suggest that ACP should not be limited to a narrow process without acknowledging the complexity surrounding personalised cancer care near the EOL.

show abstract

“…Disagreements between family or other surrogates and individual preferences are well documented, yet little information exists as to how family or surrogate characteristics may be associated with EOL expenditures. Additionally, providers make assumptions based on presumed EOL preference differences according to race and thereby contribute to overall Medicare expenditures by providing unwanted life‐sustaining care . Further research is needed to determine whether including family‐ or caregiver‐ and provider‐level factors explains more of the variation in EOL expenditures between racial and ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in End‐of‐Life Medicare Expenditures

Byhoff

Harris

Langa

et al. 2016

J American Geriatrics Society

View full text Add to dashboard Cite

Objectives To determine to what extent racial and ethnic variation in Medicare spending during the last six months of life are explained by demographic, social support, socioeconomic, geographic, medical and EOL planning factors. Design Retrospective cohort study Setting Health and Retirement Study (HRS) Participants 7,105 decedents who participated in the Health and Retirement Study between 1998–2012 and previously consented to survey linkage with Medicare claims. Measurements Total Medicare expenditures in the last 180 days of life by race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected. Results Our analysis included 5548 (78.1%) non-Hispanic white, 1030 (14.5%) non-Hispanic black, 331 (4.7%) Hispanic, and 196 (2.8%) adults of other race/ethnicity. Unadjusted results suggest that average Medicare expenditures for black decedents was $13,522 (35%, p <0.001) more than for whites, while Medicare expenditures for Hispanics was $16,341 (42%, p<0.001) more at EOL. Controlling for demographic, socioeconomic, geographic, medical and EOL specific factors, the Medicare expenditure difference between groups reduced to $8,047 (22%, p<0.001) more for black and $6,855 (19%, p<0.001) more for Hispanic decedents compared to non-Hispanic whites’ expenditures. The expenditure differences between groups remained statistically significant across all models. Conclusion Racial and ethnic differences in Medicare spending in the last six months of life are not fully explained by patient-level factors, including EOL planning factors. Future research should focus on broader systemic, organizational and provider level factors to explain these differences.

show abstract

End-of-Life Care for People With Cancer From Ethnic Minority Groups

Cited by 189 publications

References 35 publications

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

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

Factors influencing the engagement of cancer patients with advance care planning: A scoping review

Racial and Ethnic Differences in End‐of‐Life Medicare Expenditures

Contact Info

Product

Resources

About