Outcomes of End-of-Life Discussions Vary by Race

A study in the Sept. 27 issue of the Archives of Internal Medicine looked at the end-of-life care of over 300 advanced cancer patients across the country. The researchers were specifically looking at the link between end-of-life care discussions, and the care patients received in the last week of life. White patients were more likely to receive care in line with their preferences, while black patients often had more aggressive treatment, even with a DNR (do not resuscitate) order in place. Authors Jennifer W. Mack, MD, MPH; M. Elizabeth Paulk, MD; Kasisomayajula Viswanath, PhD; Holly G. Prigerson, PhD discussed some of the findings with the Harvard Crimson:

Additionally, the findings indicated that black patients did not get the end-of-life treatment they had planned for; black patients who signed “do not resuscitate” orders were just as likely to get life-prolonging treatment as black patients who did not sign such an order.

“Any mismatch can influence the way the communication process goes in the [doctor’s office],” Mack said. She said the miscommunication might be a result of black patients being treated by non-black doctors, cultural differences in the way information is interpreted, and doctors unintentionally communicating differently to black patients.

Prigerson, the principal investigator for the study, said the discrepancy might be related to the religious beliefs of black patients, who tend to be more religious than white patients. She said that end-of-life conversations have little impact on religious patients because they believe their health depends on a higher authority.

K. “Vish” Viswanath, professor at the Harvard School of Public Health and another co-author of the study, said that the cause of the disparity is unclear, but also said he thinks that making information on terminal illness easier to understand and access will help all patients to better understand their condition.

According to Prigerson, the National Cancer Institute has agreed to fund a second study to investigate why end-of-life conversations appear less effective with black patients.

The study has been reported in MedPage Today, the Los Angeles Times' Booster Shots blog, McKnight's, and HealthDay News, and The Boston Globe's White Coat Notes blog.

Hospice Foundation of America conducted this special report on African Americans and End-of-Life Care as part of it's 2009 focus on Diversity and End-of-Life Care. The report, available on DVD, examines African American attitudes about care at the end of life, offers explanations as to why hospice, historically, has not been a choice for many African Americans, looks at grief and the African American community, and suggests ways to reach out to African Americans who are making end-of-life decisions.