title: Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion.
abstract: Compared with non-Latino, white patients with advanced cancer, Latino patients with advanced cancer are less likely to sign do-not-resuscitate (DNR) orders, which is a form of advance care planning associated with better quality of life at the end of life (EOL). Latinos' completion of DNR orders may be more sensitive to clinical discussions regarding EOL care. The current study examined differences between Latino and white terminally ill patients with cancer with regard to the association between EOL discussions and DNR order completion.
  
  
  
  A total of 117 participants with advanced cancer (61 of whom were Latino and 56 of whom were non-Latino white individuals) were recruited between 2002 and 2008 from Parkland Hospital (a public hospital in Dallas, Texas) as part of the Coping with Cancer study, which is a large, multiinstitutional, prospective cohort study of patients with advanced cancer that is designed to examine social and psychological influences on EOL care. In structured interviews, patients reported if they had EOL discussions with their physicians, and if they completed DNR orders.
  
  
  
  The association between EOL discussions and DNR order completion was significantly greater in Latino compared with white patients, adjusting for potential confounds (interaction adjusted odds ratio, 6.64; P = .041). Latino patients who had an EOL discussion were >10 times more likely (adjusted odds ratio, 10.91; P = .001) to complete a DNR order than those who had not, and were found to be equally as likely to complete a DNR order as white patients.
  
  
  
  Differences in the impact of EOL discussions on DNR order completion may explain Latino/non-Latino ethnic disparities in DNR order completion in EOL care, and point to a means to eliminate those disparities. Cancer 2016;122:1749-56. © 2016 American Cancer Society.
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York.|Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
authors.forename: Megan Johnson
authors.initials: MJ
authors.lastname: Shen
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York.|Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Paulk
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York.|Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Trevino
authors.affiliation: Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Penedo
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, New York.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: Gastrointestinal Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Epstein
authors.affiliation: Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York.|Department of Epidemiology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York.|Department of Radiology, Weill Cornell Medicine, New York, New York.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
mesh_terms: D000223:Adaptation, Psychological; D016223:Advance Directives / Q000208:ethnology; D002410:Catholicism / Q000523:psychology; D003142:Communication; D003422:Critical Care; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006766:Hospitals, County; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000523:psychology*; D011787:Quality of Health Care; D012044:Regression Analysis; D012068:Religion and Medicine; D016414:Resuscitation Orders / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*; D013781:Texas; D044465:White People / Q000523:psychology*
keywords: Latino-white disparities; advanced cancer; do-not-resuscitate (DNR) order completion; end-of-life care