Male‐female patient differences in the association between end‐of‐life discussions and receipt of intensive care near death

Abstract

Background Patient gender plays a significant role in patient-physician communication, patient illness understanding and aggressiveness of end of life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The present study aims to determine if gender differences exist in receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and receipt of ICU EoL care. Methods Multi-site, prospective, cohort study of patients (N=353) with metastatic cancers, identified as terminally ill at study enrollment and interviewed a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. Results Patients who received ICU care at the EoL were more likely to be male than those who did not (73% male vs. 52% male, p=0.02). Adjusting for potential confounds, male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than male patients with no EoL discussion (AOR=0.26, 95% CI 0.07–0.91; p=0.04). There was no association between EoL discussions and ICU stays near death among female patients. Conclusions Men with advanced cancers are more likely than women to receive aggressive, non-beneficial, ICU care near death. Gender differences in effects of EoL discussions on EoL care likely contribute to, and may even explain, gender differences in receipt of ICU care in the last week of life.

End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study

“…In our study, men were found to be more exposed to chemotherapy at the end of life than women. This sex bias has been described before, both in end-of-life care settings 44 and in other settings. 45,46 These findings raise considerable concern for the quality of cancer care near the end of life, as increasing evidence suggests that continuation of chemotherapy close to death is most likely indicative of overuse.…”

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

“…Variations in quality markers of end-of-life care have been observed across physicians [8,9], health centers [10], geographical regions [11–14], and various subgroups of the population [9,15–18]. In particular, racial/ethnic disparities both in receipt of aggressive care and hospice use have been documented extensively.…”

The interactive effect of advanced cancer patient and caregiver prognostic understanding on patients' completion of Do Not Resuscitate orders

“…Given that EoL outcomes are strongly influenced by culture, including religious and racial/ethnic disparities in treatment preferences, planning, and care, research is needed to determine the generalizability of these findings across more diverse settings. That said, prior research has indicated that prognostic understanding is critical to improving EoL care planning across a variety of races, genders, and patient groups . Second, the present analyses are cross sectional.…”

“…That said, prior research has indicated that prognostic understanding is critical to improving EoL care planning across a variety of races, genders, and patient groups. 23,25,26 Second, the present analyses are cross sectional. Causal relationships between patient and caregiver prognostic understanding and completion of DNR orders cannot be inferred.…”