title: End-of-life treatment preferences: a key to reducing ethnic/racial disparities in advance care planning?
abstract: BACKGROUND
  The objective of this study was to identify targets for interventions to reduce end-of-life care disparities among patients with advanced cancer. To do this, the authors evaluated the degree to which end-of-life care values and preferences are associated with advance care planning within racial/ethnic minority groups.
  
  
  METHODS
  The Coping with Cancer study recruited patients with advanced cancer from outpatient clinics in 5 states from 2002 to 2008. Then, the rates of 1 type of advance care planning-do-not-resuscitate (DNR) orders-reported at baseline interviews by 606 patients were investigated. Bivariate tests determined associations among DNR order completion, religious values, and treatment preferences within racial/ethnic groups.
  
  
  RESULTS
  Non-Latino white patients were significantly more likely to have a DNR order (45%) than black (25%) and Latino (20%) patients (P<.001). A preference against specific life-prolonging treatment (eg, chemotherapy, ventilation) was the only factor significantly associated with higher DNR order likelihood in each group, with non-Latino white patients more likely than Latino or black patients to express preferences against life-prolonging care (eg, 26% of non-Latino white patients, 46% of black patients, and 41% of Latino patients wanted a feeding tube if it would extend life for 1 more day; P<.001).
  
  
  CONCLUSIONS
  Preferences against life-prolonging care differ dramatically by race/ethnicity, but they have a uniform significant association with DNR order completion rates across racial/ethnic groups of patients with advanced cancer. Advance care planning interventions that target preferences associated with DNR orders across racial/ethnic groups may reach a broad patient population and reduce end-of-life care disparities.
authors.affiliation: Geriatric Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, New York, New York; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Garrido
authors.forename: Shannon T
authors.initials: ST
authors.lastname: Harrington
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data; D000368:Aged; D001293:Attitude to Death; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D057240:Patient Preference / Q000208:ethnology; D044469:Racial Groups / Q000706:statistics & numerical data; D013727:Terminal Care / Q000706:statistics & numerical data
keywords: advance care planning; cardiopulmonary resuscitation; do-not-resuscitate orders; end-of-life care; health care disparities