End-of-life care and the ‘race gap’
October 30, 2009 by Carol KatarskyPosted in: Communication, Ethics, Health care/Treatment trends, In this week's e-newsletter, Latest News & Views, Patient/Client Communication
Black cancer patients are less likely to have their end-of-life care wishes followed. The question is why.
The data comes from a recent study by Holly Prigerson at the Dana-Farber Cancer Institute. The study followed 302 patients until their deaths and reviewed both their stated care preferences and the actual care they received.
Granted, the study was small, but some key differences in how white and black patients were treated emerged.
In general, black patients were far more likely to get aggressive end-of-life treatment. But, among patients who had specifically requested aggressive care, white patients were three times more likely to actually receive it.
The opposite was true among patients who stated they did not want aggressive treatment, or who signed DNRs: None of the white patients with DNRs received aggressive treatment, but several of the black patients did.
The report, published in the Journal of Clinical Oncology, suggested that at least some of the disparity in treatment can be explained by less effective communication among the caregivers of the black patients. Black patients were more likely to be transferred to other facilities, and in those cases, communication gaps may have developed.
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Tags: aggressive treatment, cancer, Communication, Dana-Farber Cancer Institute, DNRs, end-of-life care, Holly Prigerson, patient care, race
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November 4th, 2009 at 4:00 pm
In response to the next to last paragraph above:
In my 11 years of experience as a hospitalist there is a vast difference in the way some black family’s view end of life issues. Even if the patient themself requests hospice or comfort care, the family members may insist on more aggressive intervention and are sometimes antagonistic when I try to educate regarding the patient’s wishes.
I have attempted to research the reason for this disparity and have been informed it likely stems from the black community’s deep (historically well deserved) distrust of the white medical establishment.
February 4th, 2010 at 9:38 am
In response to Dr. Lovett:
I, myself being black, have found that distrust doesn’t play as much a role in the the decision as our deep-rooted faith does. The foundation for our mere existence comes from the confidence that we have in an almighty powerful and loving GOD that can turn any situation around if we don’t waiver in our trust in him. Ultimately, we know that one day we will all have to die and there is a better life promised to us. Given that, we acknowledge the fact that GOD is always in control and since we don’t have the power to create life, nor do we have any authority to decide when it should cease. I have witnessed in my own family where the doctor had given up hope but we as a family held firm to our belief and life was substained for many more fruitful years. Believe me when I say this is not always because of distrust or denial but from our historical faith commitment which enable us to endure and come out victorious through each generation.