Predictors of intensive end-of-life and hospice care in Latino and white advanced cancer patients.
BACKGROUND
The role of end-of-life (EOL) care preferences and conversations in receipt of care near death for Latinos is unclear.


OBJECTIVE
This study examines rates and predictors of intensive EOL and hospice care among Latino and white advanced cancer patients.


METHODS
Two-hundred-and-ninety-two self-reported Latino (n=58) and white (n=234) Stage IV cancer patients participated in a U.S. multisite, prospective, cohort study from September 2002 to August 2008. The Latino and white, non-Hispanic participants were interviewed and followed until death, a median of 118.5 days from baseline.


METHODS
Patient-reported, baseline predictors of EOL care included EOL care preference; terminal illness acknowledgement; EOL discussion; completion of a 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. Hospice was either in- or outpatient.


RESULTS
Latino and white patients received intensive EOL and hospice care at similar rates (5.2% and 3.4% for intensive care, p=0.88; 70.7% versus 73.4% for hospice, p=0.33). No white or Latino patient who reported a DNR order or EOL discussion at baseline received intensive EOL care. Religious coping and a preference for life-extending care predicted intensive EOL care for white patients (adjusted odds ratio [aOR] 6.69 [p=0.02] and aOR 6.63 [p=0.01], respectively), but not for Latinos. No predictors were associated with Latino hospice care.


CONCLUSIONS
EOL discussions and DNR orders may prevent intensive EOL care among Latino cancer patients. Efforts should continue to engage Latino patients and caregivers in these activities.
1 Group Health Research Institute , Group Health Co-operative, Seattle, Washington.
Elizabeth T
ET
Loggers
Paul K
PK
Maciejewski
Rachel
R
Jimenez
Matthew
M
Nilsson
Elizabeth
E
Paulk
Heather
H
Stieglitz
Holly G
HG
Prigerson
D000223:Adaptation, Psychological; D016223:Advance Directives; D001293:Attitude to Death; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D013727:Terminal Care; D014481:United States; D044465:White People / Q000523:psychology*