Racial Disparities Seen With End-of-Life Discussions

Black patients more likely to receive life-prolonging care than white patients post-EOL discussion
By Jeff Muise
HealthDay Reporter

TUESDAY, Sept. 28 (HealthDay News) -- Black patients with advanced cancer who have had end-of-life (EOL) discussions with their physicians still tend to receive more life-prolonging care than white patients who have had such discussions, according to a study in the Sept. 27 issue of the Archives of Internal Medicine.

Jennifer W. Mack, M.D., of the Dana-Farber Cancer Institute in Boston, and colleagues compared patient-physician discussions about EOL care, treatment preferences, and do-not-resuscitate (DNR) orders with the actual EOL care received by 71 black patients and 261 white patients with advanced cancer.

The researchers found that black and white patients had EOL discussions with their physicians in similar proportions (35.3 and 38.4 percent, respectively; P = .65), but more black patients than white patients received life-prolonging care at the end of life (19.7 versus 6.9 percent). Further, though EOL discussions were associated with the placement of DNR orders among black patients, black patients with such orders were no less likely to receive life-prolonging EOL care than black patients without DNR orders.

"EOL discussions and communication goals seem to assist white patients in receiving less life-prolonging EOL care, but black patients do not experience the same benefits of EOL discussions. Instead, black patients tend to receive life-prolonging measures at the EOL even when they have DNR orders or state a preference for symptom-directed care," the authors write.

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