Persistence of Racial Disparities in Advance Care Plan Documents Among Nursing Home Residents

Degenholtz, Howard B.; Arnold, Robert; Meisel, Alan; Lave, Judith R.

doi:10.1046/j.1532-5415.2002.50073.x

Cited by 150 publications

(111 citation statements)

References 16 publications

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“…Some, but not all, of these differences in end-of-life utilization are due to blacks' living in regions with higher overall end-of-life treatment intensity and spending 7 and their use of higher intensity hospitals 2,3 . Further, some of these differences may be due to minorities' lower uptake of services and strategies, such as hospice [8][9][10][11] and advance care plan documents in nursing homes 12 that change the acute care "default" near the end of life. Some of the differences may be due to systematically different preferences for treatment at the end of life among Electronic supplementary material The online version of this article (doi:10.1007/s11606-009-0952-6) contains supplementary material, which is available to authorized users.…”

Section: Resultsmentioning

confidence: 99%

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

et al. 2009

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Section: Resultsmentioning

confidence: 99%

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

et al. 2009

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“…First, our fi ndings showing that nonwhite patients were less likely to have advance directives are congruent with studies from non-ICU settings. 11,[25][26][27][28][29][30][31][32][33][34] Previous research suggests multifactorial causes for this difference, including diverse cultural beliefs and values, geographic variation in advance directive use, 32,[35][36][37] and disparities in patient-clinician communication about advance care planning. 12,14,15,26,34 Recent data support the potential value of advance directives in assuring that patients receive the care they would want.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICU

Muni

Engelberg

Treece

et al. 2011

Chest

172

130

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A growing body of evidence demonstrates the existence of important racial and ethnic differences in health care. Although many studies report on disparities in health care for acute and chronic conditions, 1-5 relatively few address racial disparities in the ICU, and those report confl icting fi ndings. Some have reported that black patients receive fewer medical interventions, 6,7 have shorter lengths of stay, and use fewer resources. 7 In contrast, others have found increased resource utilization, including larger numbers of ICU admissions and higher numbers of medical interventions for minority than for white patients. 8,9 Background: There is confl icting evidence about the infl uence of race/ethnicity on the use of intensive care at the end of life, and little is known about the infl uence of socioeconomic status. Methods: We examined patients who died in the ICU in 15 hospitals. Race/ethnicity was assessed as white and nonwhite. Socioeconomic status included patient education, health insurance, and income by zip code. To explore differences in end-of-life care, we examined the use of (1) advance directives, (2) life-sustaining therapies, (3) symptom management, (4) communication, and (5) support services. Results: Medical charts were abstracted for 3,138/3,400 patients of whom 2,479 (79%) were white and 659 (21%) were nonwhite (or Hispanic). In logistic regressions adjusted for patient demographics, socioeconomic factors, and site, nonwhite patients were less likely to have living wills (OR, 0.41; 95% CI, 0.32-0.54) and more likely to die with full support (OR, 1.59; 95% CI, 1.30-1.94). In documentation of family conferences, nonwhite patients were more likely to have documentation that prognosis was discussed (OR, 1.47; 95% CI, 1.21-1.77) and that physicians recommended withdrawal of life support (OR, 1.57; 95% CI, 1.11-2.21). Nonwhite patients also were more likely to have discord documented among family members or with clinicians (OR, 1.49; 95% CI, 1.04-2.15). Socioeconomic status did not modify these associations and was not a consistent predictor of end-of-life care. Conclusions: We found numerous racial/ethnic differences in end-of-life care in the ICU that were not infl uenced by socioeconomic status. These differences could be due to treatment preferences, disparities, or both. Improving ICU end-of-life care for all patients and families will require a better understanding of these issues.

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“…10,11 Furthermore, these care delivery gaps are more pronounced for vulnerable patient populations. [12][13][14] Care delivery innovations can improve these deficiencies. The oncology patientcentered medical home, for example, improves care effectiveness and efficiency.…”

Section: Introductionmentioning

confidence: 99%

Redesigning Cancer Care Delivery: Views From Patients and Caregivers

Patel

Periyakoil

Blayney

et al. 2017

JOP

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Introduction: Cancer is a leading cause of death in the United States. Although treatments have improved, patients and caregivers continue to report significant gaps in their care. The objective of this study was to examine the views of patients and caregivers on their experiences with current cancer care delivery and identify key strategies to improve the delivery of care. Methods and Materials: Semistructured interviews were conducted with 75 patients and 45 caregivers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis. Results: Participants reported multiple gaps in care delivery, including barriers in health communication with health care providers, lack of elucidation of care goals, lack of care coordination, and challenges in accessing care. Participants identified that greater use of nonphysician providers and alternative formats, such as telephone-based care and home and community-based care, would narrow these gaps. Conclusion: Understanding patients’ and caregivers’ experiences with gaps in cancer care delivery can inform cancer care delivery redesign efforts and lead to targeted interventions that result in patient-centered and family-oriented care.

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Persistence of Racial Disparities in Advance Care Plan Documents Among Nursing Home Residents

Cited by 150 publications

References 16 publications

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICU

Redesigning Cancer Care Delivery: Views From Patients and Caregivers

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