Racial differences in predictors of intensive end-of-life care in patients with advanced cancer.
OBJECTIVE
Black patients are more likely than white patients to receive life-prolonging care near death. This study examined predictors of intensive end-of-life (EOL) care for black and white advanced cancer patients.


METHODS
Three hundred two self-reported black (n = 68) and white (n = 234) patients with stage IV cancer and caregivers participated in a US multisite, prospective, interview-based cohort study from September 2002 to August 2008. Participants were observed until death, a median of 116 days from baseline. Patient-reported baseline predictors included EOL care preference, physician trust, EOL discussion, completion of a Do Not Resuscitate (DNR) order, and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit.


RESULTS
Although black patients were three times more likely than white patients to receive intensive EOL care (adjusted odds ratio [aOR] = 3.04, P = .037), white patients with a preference for this care were approximately three times more likely to receive it (aOR = 13.20, P = .008) than black patients with the same preference (aOR = 4.46, P = .058). White patients who reported an EOL discussion or DNR order did not receive intensive EOL care; similar reports were not protective for black patients (aOR = 0.53, P = .460; and aOR = 0.65, P = .618, respectively).


CONCLUSIONS
White patients with advanced cancer are more likely than black patients with advanced cancer to receive the EOL care they initially prefer. EOL discussions and DNR orders are not associated with care for black patients, highlighting a need to improve communication between black patients and their clinicians.
Loggers
Elizabeth Trice
ET
Department of MedicalOncology, Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute Boston, MA 02114, USA.
Maciejewski
Paul K
PK
Paulk
Elizabeth
E
DeSanto-Madeya
Susan
S
Nilsson
Matthew
M
Viswanath
Kasisomayajula
K
Wright
Alexi Anne
AA
Balboni
Tracy A
TA
Temel
Jennifer
J
Stieglitz
Heather
H
Block
Susan
S
Prigerson
Holly G
HG
D032722:Advance Care Planning / Q000639:trends*; D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death / Q000208:ethnology*; D017028:Caregivers / Q000706:statistics & numerical data; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D044469:Racial Groups / Q000208:ethnology; D016414:Resuscitation Orders; D018570:Risk Assessment; D016019:Survival Analysis; D013727:Terminal Care / Q000639:trends; D044465:White People / Q000208:ethnology*