The Relationship Between Ethnicity and Advance Directives in a Frail Older Population

Eleazer, G. Paul; Hornung, Carlton A.; Egbert, Carolyn B.; Egbert, John; Eng, Catherine; Hedgepeth, Jennifer; McCann, Robert M.; Strothers, Harry; Sapir, Marc; Mao, Wei; Wilson, Malissa

doi:10.1111/j.1532-5415.1996.tb01864.x

Cited by 157 publications

(125 citation statements)

References 12 publications

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“…The trend toward lower ACP completion among minorities and Hispanics, and the significantly lower ACP completion rate among those with less income and education, are consistent with findings of other studies. 10,11,[24][25][26] Interestingly, in our population these effects were all reversed in women, and were not merely due to confounding by socioeconomic factors. ACP completion among women was surprisingly low, in sharp contrast with prior studies in both HIV-infected and uninfected populations in whom gender differences were negligible or favored completion in women.…”

Section: Discussionmentioning

confidence: 48%

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

Erlandson

Allshouse²,

Duong³

et al. 2012

Journal of Palliative Medicine

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Introduction: Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the ''graying'' of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons. Methods: HIV-1-seropositive persons aged 45-65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender. Results: Of 238 participants, 112 (47%) completed ACP. Persons ‡ 55 years of age (OR 2.8; CI 1.6,5.0; p < 0.001), males (OR 4.1; CI 1.8,9.3; p = 0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p = 0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p = 0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p = 0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p = 0.4). Current CD4+ cell counts were similar between those completing and not completing documentation (588 cells/lL and 604 cells/lL, respectively; p = 0.7). The likelihood of ACP did not significantly differ with other comorbidities. Discussion: Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP.

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Section: Discussionmentioning

confidence: 48%

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

Erlandson

Allshouse²,

Duong³

et al. 2012

Journal of Palliative Medicine

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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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“…Advance care planning (ACP) is the process by which patients, in conjunction with their physicians and loved ones, establish goals and preferences for future care and codify these preferences in written documents such as a living will, durable power of attorney for health care decision making (health care proxy), or Do-Not-Resuscitate (DNR) order. 4,5 Despite well-documented racial and ethnic differences in ACP, [6][7][8][9][10][11][12][13] we know little about why these differences exist. Previous research suggest that differences in acknowledgment of terminal illness, religiousness, and treatment preferences are important in ACP, but none…”

Section: Introductionmentioning

confidence: 99%

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

Smith

McCarthy

Paulk

et al. 2008

JCO

236

214

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A B S T R A C T PurposeDespite well-documented racial and ethnic differences in advance care planning (ACP), we know little about why these differences exist. This study tested proposed mediators of racial/ethnic differences in ACP. Patients and MethodsWe studied 312 non-Hispanic white, 83 non-Hispanic black, and 73 Hispanic patients with advanced cancer in the Coping with Cancer study, a federally funded multisite prospective cohort study designed to examine racial/ethnic disparities in ACP and end-of-life care. We assessed the impact of terminal illness acknowledgment, religiousness, and treatment preferences on racial/ethnic differences in ACP. ResultsCompared with white patients, black and Hispanic patients were less likely to have an ACP (white patients, 80%; black patients, 47%; Hispanic patients, 47%) and more likely to want life-prolonging care even if he or she had only a few days left to live (white patients, 14%; black patients, 45%; Hispanic patients, 34%) and to consider religion very important (white patients, 44%; black patients, 88%; Hispanic patients, 73%; all P Ͻ .001, comparison of black or Hispanic patients with white patients). Hispanic patients were less likely and black patients marginally less likely to acknowledge their terminally ill status (white patients, 39% v Hispanic patients, 11%; P Ͻ .001; white v black patients, 27%; P ϭ .05). Racial/ethnic differences in ACP persisted after adjustment for clinical and demographic factors, terminal illness acknowledgment, religiousness, and treatment preferences (has ACP, black v white patients, adjusted relative risk, 0.64 [95% CI, 0.49 to 0.83]; Hispanic v white patients, 0.65 [95% CI, 0.47 to 0.89]). ConclusionAlthough black and Hispanic patients are less likely to consider themselves terminally ill and more likely to want intensive treatment, these factors did not explain observed disparities in ACP.

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The Relationship Between Ethnicity and Advance Directives in a Frail Older Population

Cited by 157 publications

References 12 publications

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

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

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

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