End-of-life care differs by race: study
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The way that older adults with advanced cancer live out their last days seems to vary based on race, a US study suggests.
Researchers found that of nearly 41,000 older Americans with terminal cancer, black and Asian patients were less likely than their white or Hispanic counterparts to be enrolled in a hospice program.
On the other hand, they were more likely to be hospitalized frequently or admitted to an intensive care unit near the end of their lives. They were also more likely than whites or Hispanics to die in the hospital, according to the study findings published in the Journal of the American Geriatrics Society.
The results are in line with past studies showing similar racial disparities in hospice care—programs that focus on treating pain and other physical and emotional symptoms to make patients more comfortable in their last months of life.
But the reasons for the discrepancies remain unclear, according to the researchers, led by Dr. Alexander K. Smith of Beth Israel Deaconess Medical Center in Boston.
All of the patients in their study were age 65 or older and had health insurance through Medicare. Even when the researchers accounted for other factors—like patients’ incomes and their physical health—race itself was still related to end-of-life care.
Black patients were 9 percent less likely than whites to enroll in a hospice program, while Asian patients were 24 percent less likely. They were also 26 percent and 17 percent more likely, respectively, to be hospitalized at least twice in their last month of life.
It’s possible, Smith and his colleagues note, that patients’ personal preferences at least partly explain the findings.
The researchers point out that a number of studies have found that black patients are less open to hospice care than white patients are, and are more likely to prefer continuing with aggressive treatments. Little is known about Asian-American patients’ views.
It will be important to find out whether patients’ preferences, unequal access to healthcare, or both are fueling racial differences in end-of-life care, according to Smith and his colleagues.
“Improved understanding,” they write, “will hopefully lead to interventions that improve end-of-life care for all patients with advanced cancer.”
SOURCE: Journal of the American Geriatrics Society, January 2009.
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