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Black Patients Less Likely to Get End-of-Life Care They Request

Those dying are more likely than whites to receive aggressive life-prolonging treatment against their wishes, study finds

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MONDAY, Sept. 27, 2010 (HealthDay News) -- Black patients are less likely than whites to receive the type of end-of-life care they request, even though both groups have similar rates of end-of-life discussions with their doctors, says U.S. researchers.

"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," wrote Dr. Jennifer W. Mack, of the Dana-Farber Cancer Institute in Boston, and colleagues.

They studied 332 white and black adult patients with terminal cancer and found that black patients and white patients had similar rates of end-of-life talks with doctors, but that black patients were less likely to be aware that their cancer was terminal.

"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 (do not resuscitate) order in place. White patients were also less likely to receive life-prolonging care in their last week of life," the researchers reported.

They also found that "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."

For example, black patients with DNR orders are just as likely to receive life-prolonging treatment as black patients without DNR orders.

Among the other findings:

  • Black patients who had end-of-life discussions with their doctors had a shorter survival time after baseline assessment than white patients who did not have such discussions.
  • Black patients with more education were slightly more likely than those with less education to have end-of-life discussions with their doctors.

The researchers concluded that "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."

The study appears Sept. 27 in the journal Archives of Internal Medicine.

More information

The U.S. Agency for Healthcare Research and Quality has more about end-of-life decisions.

SOURCE: Archives of Internal Medicine, news release, Sept. 27, 2010.


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