Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion

Megan Johnson Shen, Holly G. Prigerson, Elizabeth Paulk, Kelly M. Trevino, Frank J. Penedo, Ana I. Tergas, Andrew S. Epstein, Alfred I. Neugut, Paul K. MacIejewski

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Original languageEnglish (US)
Pages (from-to)1749-1756
Number of pages8
JournalCancer
Volume122
Issue number11
DOIs
StatePublished - Jun 1 2016

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Resuscitation Orders
Hispanic Americans
Terminal Care
Neoplasms
Odds Ratio
Advance Care Planning
Terminally Ill
Public Hospitals
Cohort Studies
Quality of Life
Prospective Studies
Interviews
Psychology
Physicians

Keywords

  • advanced cancer
  • do-not-resuscitate (DNR) order completion
  • end-of-life care
  • Latino-white disparities

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Shen, M. J., Prigerson, H. G., Paulk, E., Trevino, K. M., Penedo, F. J., Tergas, A. I., ... MacIejewski, P. K. (2016). Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion. Cancer, 122(11), 1749-1756. https://doi.org/10.1002/cncr.29973

Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion. / Shen, Megan Johnson; Prigerson, Holly G.; Paulk, Elizabeth; Trevino, Kelly M.; Penedo, Frank J.; Tergas, Ana I.; Epstein, Andrew S.; Neugut, Alfred I.; MacIejewski, Paul K.

In: Cancer, Vol. 122, No. 11, 01.06.2016, p. 1749-1756.

Research output: Contribution to journalArticle

Shen, MJ, Prigerson, HG, Paulk, E, Trevino, KM, Penedo, FJ, Tergas, AI, Epstein, AS, Neugut, AI & MacIejewski, PK 2016, 'Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion', Cancer, vol. 122, no. 11, pp. 1749-1756. https://doi.org/10.1002/cncr.29973
Shen, Megan Johnson ; Prigerson, Holly G. ; Paulk, Elizabeth ; Trevino, Kelly M. ; Penedo, Frank J. ; Tergas, Ana I. ; Epstein, Andrew S. ; Neugut, Alfred I. ; MacIejewski, Paul K. / Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion. In: Cancer. 2016 ; Vol. 122, No. 11. pp. 1749-1756.
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title = "Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion",
abstract = "BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.",
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author = "Shen, {Megan Johnson} and Prigerson, {Holly G.} and Elizabeth Paulk and Trevino, {Kelly M.} and Penedo, {Frank J.} and Tergas, {Ana I.} and Epstein, {Andrew S.} and Neugut, {Alfred I.} and MacIejewski, {Paul K.}",
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T1 - Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion

AU - Shen, Megan Johnson

AU - Prigerson, Holly G.

AU - Paulk, Elizabeth

AU - Trevino, Kelly M.

AU - Penedo, Frank J.

AU - Tergas, Ana I.

AU - Epstein, Andrew S.

AU - Neugut, Alfred I.

AU - MacIejewski, Paul K.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

AB - BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

KW - advanced cancer

KW - do-not-resuscitate (DNR) order completion

KW - end-of-life care

KW - Latino-white disparities

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