Problematic Integration: Racial Discordance in End-of-Life Decision Making

Drummond, Darlene K.; Kaur‐Gill, Satveer; Murray, Genevra F.; Schifferdecker, Karen E.; Butcher, Rebecca L.; Perry, Amanda; Brooks, Gabriel A.; Kapadia, Nirav S.; Barnato, Amber E.

doi:10.1080/10410236.2022.2111631

Cited by 4 publications

(1 citation statement)

References 49 publications

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“…Racial discordance between physicians and patients has consistently been associated with poor communication in general 14 and the heightened complexity of Serious Illness communication may make these discussions fraught. 15 Missed opportunities and communication failures are more common when physicians are caring for Black compared with White patients. [16][17][18] Physician implicit bias may be an important factor in racially discordant relationships and can affect patient ratings in domains critical to quality end-of-life care including interpersonal treatment, communication and trust.…”

Section: Introductionmentioning

confidence: 99%

Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations?

Swiderski

Chuang

2023

Am J Hosp Palliat Care

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Background Advance Care Planning (ACP) has not reliably improved care for patients at end-of-life. Serious Illness Conversations when patients are in the late stages of chronic illness might be more effective to address patients’ goals. The Serious Illness Conversation (SIC) Guide has been helpful but was not developed for use in safety-net settings serving racial and ethnic minority populations. Methods Physicians were recruited to complete a needs assessment survey prior to training in the use of the SIC Guide. Results Of the 44 physician participants, most were female (82%) and white, non-Hispanic (62%). Less than half of respondents rated themselves as skilled or very skilled in basic serious illness communication related tasks such as setting up goals of care discussions (44%), assessing informational preferences (42%), sharing prognosis (38%), exploring goals for future care (49%) and managing family dynamics (44%). Respondents reported lower skill levels in conducting goals of care conversations via telehealth and establishing trust in racially discordant provider/patient pairs. Conclusions Most participants expressed the need for further training in critical end-of-life communications skills, including help with encounters with racial and/or language discordance. This may help to explain the failure of ACP discussions to reliably result in appropriate end-of-life care.

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Section: Introductionmentioning

confidence: 99%

Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations?

Swiderski

Chuang

2023

Am J Hosp Palliat Care

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Implantable cardioverter defibrillators in people dying with cancer: A SEER‐Medicare analysis of ICD prevalence and association with aggressive end‐of‐life care

Mullins,

Wang,

Shahan

et al. 2024

Cancer

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IntroductionThe shared risk profiles for cancer and heart disease suggest many individuals with cancer may have an implantable cardioverter defibrillator (ICD). ICDs can have dramatic cancer end‐of‐life care implications including painful and distressing shocks. ICD prevalence and association with aggressive end‐of‐life care among individuals with breast, colorectal, and pancreatic cancer was evaluated using the Surveillance, Epidemiology, and End Results‐Medicare dataset.MethodsA total of 37,306 Medicare beneficiaries aged ≥66 years with stage 3 or 4 cancer who died between 2005 and 2016 were identified. ICD prevalence, ICD‐related care utilization that might present opportunities to discuss end‐of‐life implications and association with aggressive end‐of‐life care (>1 emergency department visit, intensive care unit admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive or life‐extending procedures) in the last month of life was assessed using multivariable logistic regression.ResultsAmong cancer decedents, 6% had an ICD. More individuals with an ICD (31%) died in the hospital than individuals without an ICD (25%; p < .001). Half (46%) of individuals with an ICD had device programming or interrogation visits that could be an opportunity for device discussion. In adjusted models, ICD presence was associated with higher odds of every indicator of aggressive end‐of‐life care other than chemotherapy.ConclusionMany older cancer decedents in the United States had an ICD, and those with ICDs received more aggressive care at the end of life. Results suggest there are opportunities to discuss ICD and goals of care, raise awareness and encourage shared decision‐making for this population to ensure goal‐concordant care, and improve end‐of‐life care quality.

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Power and racial differences in the communication experiences of Black and White patients living with advanced cancer and their care partners: An application of co-cultural theory

Drummond,

Kaur-Gill,

Zhang

et al. 2024

Communication Monographs

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Problematic Integration: Racial Discordance in End-of-Life Decision Making

Cited by 4 publications

References 49 publications

Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations?

Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations?

Implantable cardioverter defibrillators in people dying with cancer: A SEER‐Medicare analysis of ICD prevalence and association with aggressive end‐of‐life care

Power and racial differences in the communication experiences of Black and White patients living with advanced cancer and their care partners: An application of co-cultural theory

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