End of life care and counseling are important to anyone near death. However, this care has been found to be discriminatory when such care implementation is compared between white and black patients. All truly benefit from discussions about the final days of life with their trusted physicians, but black persons tend to get less customized care based on their preferences in comparison. The September 27 issue of Archives of Internal Medicine, a JAMA journal, delves deeper into these observations in a study supported by a grant from the National Institute of Mental Health, a grant from the National Cancer Institute, by a Fetzer Religion at the End-of-Life Grant and by the Center for Psycho-oncology and Palliative Care Research, Dana-Farber Cancer Institute.
Jennifer W. Mack, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston found that black patients equally conducted end-of-life discussions compared to whites. However, in a surprising report, black persons were far less aware that their illness was even terminal. Level of education played a small factor in survival rates and likelihood for black patients to have these end of life consultations with their doctors. Patients with fewer years of education appear to be less likely to bring up the personal desire for such bedside chats.
Dr. Mack states:
Although black patients are also more likely than white patients to desire life-prolonging measures, receipt of life-prolonging care at the end of life is associated with greater distress and with poorer quality of life. These findings raise the concern that black patients receive inferior end-of-life care, a possibility underscored by disparities between black patients and white patients in certain objective care measures, such as pain management.
Three hundred and thirty two patients’ cases from October 2002 and September 2007 were reviewed and tracked. All patients, either white (non-Hispanic) and black had been diagnosed with cancer with distant metastases, or cancer that has spread from the origin to other parts of the body, and first-line chemotherapy proved unsuccessful. All subjects passed away during the study and were over 20 years of age.
There are many preferences a dying patient can or cannot elect. Do Not Resuscitate (DNR) orders, aggressive life prolonging care and communication goals are just a few personal decisions the dying and loved ones face. In the study, it appears black patients’ wishes are not adhered to. In unjustified reports, those humans without DNR orders are just as likely to receive life-prolonging treatment as black patients with a DNR.
Mack and associates continue:
Despite similar rates of end-of-life discussions, white patients were more likely than black patients to prefer symptom-directed care over life-prolonging end-of-life care and to have DNR orders in place. White patients were also less likely to receive life-prolonging care in their last week of life. Although end-of-life discussions and communication goals assist white patients in receiving less burdensome life-prolonging care at the end-of-life, black patients tend to receive more aggressive care regardless of their preferences.
In sobering conclusion, the authors write:
Although the reasons for our findings are not fully understood, white patients appear to have undefined advantages when it comes to receiving end-of-life care that reflects their values.
Jennifer W. Mack, MD, MPH; M. Elizabeth Paulk, MD; Kasisomayajula Viswanath, PhD; Holly G. Prigerson, PhD
Arch Intern Med. 2010;170(17):1533-1540. doi:10.1001/archinternmed.2010.322
Written by Sy Kraft (B.A.)