Racial gaps in end-of-life care reported

Black patients with advanced cancer are less likely than white patients to have their wishes for end-of-life care honored, a new study in the Archives of Internal Medicine reports, even though black and white patients were just as likely to have discussed their preferences with their doctors.

Dr. Jennifer Mack of Dana-Farber Cancer Institute led a team that looked for a link between end-of-life discussions and what actually happened in the last week of cancer patients’ lives. Previous research has shown that black patients are more likely than white patients to say they want treatments that extend life, including being placed on a ventilator to take over their breathing, having CPR if their hearts stopped beating, or being admitted to a hospital intensive care unit. White patients are more likely to choose palliative care, including hospice, which focuses on easing pain and discomfort rather than extending life.

Research has also found that black patients’ preferences aren’t necessarily followed. Mack and her colleagues wanted to know if the conversations patients had with their doctors might explain the disparity. They interviewed 71 black patients and 261 white patients whose cancer had spread and for whom chemotherapy had failed. About the same proportion -- 35 percent of black patients and 38 percent of white patients -- said they had talked with their doctors about end-of life care.

But there were differences when the researchers asked patients about their illnesses. Fewer black patients than white patients with advanced cancer -- 32 percent vs. 47 percent -- said their cancer was terminal, suggesting problems with communication between doctors and patients.

After the patients had died, the researchers reviewed the kind of care they received. They found that even if black patients had signed “do not resuscitate” orders, they were just as likely to get the life-prolonging treatment as black patients without DNR orders.

“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,” 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. Care of black patients at the [end of life] must be brought to the same standard.”