title: Racial disparities in the outcomes of communication on medical care received near death.
abstract: BACKGROUND
  Black patients tend to receive more life-prolonging care at the end of life (EOL) than white patients. This study aimed to evaluate whether differences in patient-physician communication contribute to disparities in EOL care between black patients and white patients.
  
  
  METHODS
  Multi-institutional prospective longitudinal cohort study of 71 black patients and 261 white patients with advanced cancer. The main outcome measures were differences between black patients and white patients in relationships among EOL discussions and communication goals (terminal illness awareness, treatment preferences, and do-not-resuscitate [DNR] orders) and EOL care outcomes (life-prolonging care, hospice care, and receipt of EOL care consistent with preferences).
  
  
  RESULTS
  End-of-life discussions between physicians and their white patients were associated with less life-prolonging EOL care compared with their black patients (adjusted odds ratio [aOR], 0.11; P = .04). Despite similar rates of EOL discussions (black vs white patients 35.3% vs 38.4%, P = .65), more black patients than white patients received life-prolonging EOL care (19.7% vs 6.9%, P = .001). End-of-life discussions were associated with attainment of some communication goals among black patients, including placement of DNR orders (aOR, 4.25; P = .04), but these communication goals were not consistently associated with EOL care received by black patients. For example, black patients with DNR orders were no less likely than black patients without DNR orders to receive life-prolonging EOL care (aOR, 1.57; P = .58).
  
  
  CONCLUSIONS
  End-of-life discussions and communication goals seem to assist white patients in receiving less life-prolonging EOL care, but black patients do not experience the same benefits of EOL discussions. Instead, black patients tend to receive life-prolonging measures at the EOL even when they have DNR orders or state a preference for symptom-directed care.
authors.affiliation: Department of Pediatric Oncology and Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. Jennifer_Mack@dfci.harvard.edu
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Paulk
authors.forename: Kasisomayajula
authors.initials: K
authors.lastname: Viswanath
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D032722:Advance Care Planning / Q000639:trends*; D001741:Black or African American / Q000706:statistics & numerical data*; D001293:Attitude to Death / Q000208:ethnology*; D003142:Communication; D005260:Female; D017051:Hospice Care / Q000639:trends; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011788:Quality of Life; D016414:Resuscitation Orders; D013727:Terminal Care / Q000639:trends*; D044465:White People / Q000706:statistics & numerical data*