title: End-of-Life Care for People With Cancer From Ethnic Minority Groups: A Systematic Review.
abstract: BACKGROUND
  Ethnic/racial minorities encounter disparities in healthcare, which may carry into end-of-life (EOL) care. Advanced cancer, highly prevalent and morbid, presents with worsening symptoms, heightening the need for supportive and EOL care.
  
  
  OBJECTIVE
  To conduct a systematic review examining ethnic/racial disparities in EOL care for cancer patients.
  
  
  METHODS
  We searched four electronic databases for all original research examining EOL care use, preferences, and beliefs for cancer patients from ethnic/racial minority groups.
  
  
  RESULTS
  Twenty-five studies were included: 20 quantitative and five qualitative. All had a full-text English language article and focused on the ethnic/racial minority groups of African Americans, Hispanics Americans, or Asian Americans. Key themes included EOL decision making processes, family involvement, provider communication, religion and spirituality, and patient preferences. Hospice was the most studied EOL care, and was most used among Whites, followed by use among Hispanics, and least used by African and Asian Americans. African Americans perceived a greater need for hospice, yet more frequently had inadequate knowledge. African Americans preferred aggressive treatment, yet EOL care provided was often inconsistent with preferences. Hispanics and African Americans less often documented advance care plans, citing religious coping and spirituality as factors.
  
  
  CONCLUSIONS
  EOL care differences among ethnic/racial minority cancer patients were found in the processes, preferences, and beliefs regarding their care. Further steps are needed to explore the exact causes of differences, yet possible explanations include religious or cultural differences, caregiver respect for patient autonomy, access barriers, and knowledge of EOL care options.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: LoPresti
authors.affiliation: Department of Medical Library, New York University School of Medicine, New York, NY, USA.
authors.forename: Fritz
authors.initials: F
authors.lastname: Dement
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA heather.gold@nyumc.org.
authors.forename: Heather T
authors.initials: HT
authors.lastname: Gold
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D003142:Communication; D003657:Decision Making; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017051:Hospice Care / Q000458:organization & administration; D006801:Humans; D008913:Minority Groups; D009369:Neoplasms / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D026684:Personal Autonomy; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data*; D012067:Religion; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology; D035502:Trust
keywords: cancer; end-of-life care; ethnic or racial minorities; systematic review