title: Preferences for aggressive care in underserved populations with advanced-stage lung cancer: looking beyond race and resuscitation.
abstract: OBJECTIVE
  This paper examines the relationship between race, religiousness, spiritual well-being, antitumor treatment and preference for aggressive care among Black and White patients with advanced stage lung cancer receiving ambulatory cancer care in an urban setting.
  
  
  METHODS
  A cross-sectional exploration of patients enrolled in a Cleveland-based longitudinal study after initial diagnosis of advanced lung cancer were interviewed in Cleveland regarding religiousness, spiritual well-being, preferences for cardiopulmonary resuscitation (CPR), goals of aggressive care, and willingness to tolerate adverse health states. Receipt of antitumor treatment was identified from medical records.
  
  
  RESULTS
  We analyzed data from 67 Black and 129 White patients (N=196). Regression analysis for CPR showed that race was not associated with preference for CPR (OR=1.12, CI 0.44-2.85). The odds of choosing CPR were three times higher among patients receiving antitumor treatment (OR=3.26, CI 1.12-9.44). Greater willingness to endure adverse health states was associated with higher spiritual well-being scores (b=0.12, CI 0.01-0.25). Choosing goals to extend life versus relieve pain was higher among persons with higher spiritual well-being as well (RRR=1.08, CI 1.01-1.16), yet the relationship with religiousness was negative (RRR=0.46, CI 0.22-0.98).
  
  
  CONCLUSIONS
  After controlling for multiple factors, race was associated only with CPR, but not with other measures of preference for aggressive care. In addition, receipt of active antitumor treatment was positively associated with preference for CPR and spiritual well-being was important to setting end-of-life care goals and perspectives. Future directions for tailoring end-of-life care decision-making initiatives should move beyond race and discussions of CPR alone and focus on a full spectrum of patient beliefs and preferences at the end of life.
authors: Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA, gxk56@case.edu.
authors: George
authors: G
authors: Kypriotakis
authors: Linda E
authors: LE
authors: Francis
authors: Elizabeth
authors: E
authors: O'Toole
authors: Tanyanika Phillips
authors: TP
authors: Towe
authors: Julia Hannum
authors: JH
authors: Rose
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000523:psychology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012068:Religion and Medicine; D029181:Spirituality; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D035862:Vulnerable Populations / Q000208:ethnology / Q000523:psychology*; D044465:White People / Q000523:psychology*