Race does not influence do-not-resuscitate status or the number or timing of end-of-life care discussions at a pediatric oncology referral center.
BACKGROUND
End-of-life care (EOLC) discussions and decisions are common in pediatric oncology. Interracial differences have been identified in adult EOLC preferences, but the relation of race to EOLC in pediatric oncology has not been reported. We assessed whether race (white, black) was associated with the frequency of do-not-resuscitate (DNR) orders, the number and timing of EOLC discussions, or the timing of EOLC decisions among patients treated at our institution who died.


METHODS
We reviewed the records of 380 patients who died between July 1, 2001 and February 28, 2005. Chi(2) and Wilcoxon rank-sum tests were used to test the association of race with the number and timing of EOLC discussions, the number of DNR changes, the timing of EOLC decisions (i.e., DNR order, hospice referral), and the presence of a DNR order at the time of death. These analyses were limited to the 345 patients who self-identified as black or white.


RESULTS
We found no association between race and DNR status at the time of death (p = 0.57), the proportion of patients with DNR order changes (p = 0.82), the median time from DNR order to death (p = 0.51), the time from first EOLC discussion to DNR order (p = 0.12), the time from first EOLC discussion to death (p = 0.33), the proportion of patients who enrolled in hospice (p = 0.64), the time from hospice enrollment to death (p = 0.2) or the number of EOLC discussions before a DNR decision (p = 0.48).


CONCLUSIONS
When equal access to specialized pediatric cancer care is provided, race is not a significant factor in the presence or timing of a DNR order, enrollment in or timing of enrollment in hospice, or the number or timing of EOLC discussions before death.
Baker
Justin N
JN
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. justin.baker@stjude.org
Rai
Shesh
S
Liu
Wei
W
Srivastava
Kumar
K
Kane
Javier R
JR
Zawistowski
Christine A
CA
Burghen
Elizabeth A
EA
Gattuso
Jami S
JS
West
Nancy
N
Althoff
Jennifer
J
Funk
Adam
A
Hinds
Pamela S
PS
D000293:Adolescent; D044383:Black People; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D010372:Pediatrics; D016414:Resuscitation Orders; D013727:Terminal Care; D014481:United States; D044465:White People; D001741:Black or African American