Race, Ethnicity May Influence ICU End-of-Life Care

Nonwhite patients less likely to have living wills, more likely to die with full support

WEDNESDAY, May 4 (HealthDay News) -- Racial and ethnic differences that are independent of socioeconomic status may be present in end-of-life care in intensive care units (ICU), according to a study published in the May issue of Chest.

Sarah Muni, M.D., from the University of California in San Francisco, and colleagues examined the influence of race/ethnicity and socioeconomic status on the use of intensive care at the end of life. Medical charts from 3,183 patients (2,479 of whom were white) from ICUs in 15 hospitals were analyzed to identify differences in the use of advance directives, life-sustaining therapies, symptom management, communication, and support services as part of end-of-life care.

The investigators found that, after adjusting for demographics, socioeconomic status, and site, nonwhite patients had a lower likelihood of having living wills (odds ratio [OR], 0.41) and a higher likelihood of dying with full support (OR, 1.59). Nonwhite patients were more likely to have documentation of a family conference where prognosis was discussed (OR, 1.47), physician's recommendations for withdrawal of life support (OR, 1.57), and discord within families or between families and clinicians (OR, 1.49). These associations were not modified by socioeconomic status.

"This study supports the growing body of evidence that racial and ethnic differences exist in end-of-life care. Some of these differences are likely due to differences in treatment preferences and values, but others may represent disparities in health care at the end of life," the authors write.

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