Racial differences in predictors of intensive end-of-life care in patients with advanced cancer

Elizabeth Trice Loggers, Paul K. Maciejewski, Elizabeth Paulk, Susan DeSanto-Madeya, Matthew Nilsson, Kasisomayajula Viswanath, Alexi Anne Wright, Tracy A. Balboni, Jennifer Temel, Heather Stieglitz, Susan Block, Holly G. Prigerson

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Abstract

Purpose: Black patients are more likely than white patients to receive life-prolonging care near death. This study examined predictors of intensive end-of-life (EOL) care for black and white advanced cancer patients. Patients and Methods: Three hundred two self-reported black (n = 68) and white (n = 234) patients with stage IV cancer and caregivers participated in a US multisite, prospective, interview-based cohort study from September 2002 to August 2008. Participants were observed until death, a median of 116 days from baseline. Patient-reported baseline predictors included EOL care preference, physician trust, EOL discussion, completion of a Do Not Resuscitate (DNR) order, and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. Results: Although black patients were three times more likely than white patients to receive intensive EOL care (adjusted odds ratio [aOR] = 3.04, P = .037), white patients with a preference for this care were approximately three times more likely to receive it (aOR = 13.20, P = .008) than black patients with the same preference (aOR = 4.46, P = .058). White patients who reported an EOL discussion or DNR order did not receive intensive EOL care; similar reports were not protective for black patients (aOR = 0.53, P = .460; and aOR = 0.65, P = .618, respectively). Conclusion: White patients with advanced cancer are more likely than black patients with advanced cancer to receive the EOL care they initially prefer. EOL discussions and DNR orders are not associated with care for black patients, highlighting a need to improve communication between black patients and their clinicians.

Original languageEnglish (US)
Pages (from-to)5559-5564
Number of pages6
JournalJournal of Clinical Oncology
Volume27
Issue number33
DOIs
StatePublished - Nov 20 2009

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Terminal Care
Neoplasms
Resuscitation Orders
Odds Ratio
Caregivers
Interviews
Resuscitation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Loggers, E. T., Maciejewski, P. K., Paulk, E., DeSanto-Madeya, S., Nilsson, M., Viswanath, K., ... Prigerson, H. G. (2009). Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. Journal of Clinical Oncology, 27(33), 5559-5564. https://doi.org/10.1200/JCO.2009.22.4733

Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. / Loggers, Elizabeth Trice; Maciejewski, Paul K.; Paulk, Elizabeth; DeSanto-Madeya, Susan; Nilsson, Matthew; Viswanath, Kasisomayajula; Wright, Alexi Anne; Balboni, Tracy A.; Temel, Jennifer; Stieglitz, Heather; Block, Susan; Prigerson, Holly G.

In: Journal of Clinical Oncology, Vol. 27, No. 33, 20.11.2009, p. 5559-5564.

Research output: Contribution to journalArticle

Loggers, ET, Maciejewski, PK, Paulk, E, DeSanto-Madeya, S, Nilsson, M, Viswanath, K, Wright, AA, Balboni, TA, Temel, J, Stieglitz, H, Block, S & Prigerson, HG 2009, 'Racial differences in predictors of intensive end-of-life care in patients with advanced cancer', Journal of Clinical Oncology, vol. 27, no. 33, pp. 5559-5564. https://doi.org/10.1200/JCO.2009.22.4733
Loggers, Elizabeth Trice ; Maciejewski, Paul K. ; Paulk, Elizabeth ; DeSanto-Madeya, Susan ; Nilsson, Matthew ; Viswanath, Kasisomayajula ; Wright, Alexi Anne ; Balboni, Tracy A. ; Temel, Jennifer ; Stieglitz, Heather ; Block, Susan ; Prigerson, Holly G. / Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. In: Journal of Clinical Oncology. 2009 ; Vol. 27, No. 33. pp. 5559-5564.
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abstract = "Purpose: Black patients are more likely than white patients to receive life-prolonging care near death. This study examined predictors of intensive end-of-life (EOL) care for black and white advanced cancer patients. Patients and Methods: Three hundred two self-reported black (n = 68) and white (n = 234) patients with stage IV cancer and caregivers participated in a US multisite, prospective, interview-based cohort study from September 2002 to August 2008. Participants were observed until death, a median of 116 days from baseline. Patient-reported baseline predictors included EOL care preference, physician trust, EOL discussion, completion of a Do Not Resuscitate (DNR) order, and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. Results: Although black patients were three times more likely than white patients to receive intensive EOL care (adjusted odds ratio [aOR] = 3.04, P = .037), white patients with a preference for this care were approximately three times more likely to receive it (aOR = 13.20, P = .008) than black patients with the same preference (aOR = 4.46, P = .058). White patients who reported an EOL discussion or DNR order did not receive intensive EOL care; similar reports were not protective for black patients (aOR = 0.53, P = .460; and aOR = 0.65, P = .618, respectively). Conclusion: White patients with advanced cancer are more likely than black patients with advanced cancer to receive the EOL care they initially prefer. EOL discussions and DNR orders are not associated with care for black patients, highlighting a need to improve communication between black patients and their clinicians.",
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AU - Nilsson, Matthew

AU - Viswanath, Kasisomayajula

AU - Wright, Alexi Anne

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AU - Temel, Jennifer

AU - Stieglitz, Heather

AU - Block, Susan

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