Thursday, September 11, 2008

Ethnic differences in advance care planning

Another recent Journal of Clinical Oncology has a study about racial and ethnic differences in advance care planning in cancer patients.  This is an analysis of the Coping with Cancer Study data (which we've blogged about before and I won't go into detail about again other than to say it was a large prospective multi-institutional study involving several hundred cancer patients all of whom had a likely prognosis of less than 6 months at the time of study enrollment).  They found that Black and Hispanic patients were less likely to have an advance directive than white patients (and in this case much less likely: 80% vs 50%),  were more religious, and were more likely to endorse life-prolonging treatment wishes even if had only a few days to live.  Dishearteningly, only 30% of patients had had any sort of discussion with their physicians regarding end of life care - this finding did not differ between groups.  Fewer Black and Hispanic patients acknowledged they were terminally ill compared to white patients, however such acknowledgment was associated with increased advance care planning in all groups.  The really interesting finding is that differences in advance care planning persisted even after adjusting for demographic factors (age, education level, etc.), terminal illness awareness, religiosity, and preference for life-prolonging therapy when dying.  Suggesting, that is, that these differences are either deeply cultural (and thus not as impacted by demographics, illness understanding, etc.) and/or related to how/the frequency with which clinicians bring up advance care planning with patients from different ethnic groups.  

There has been a flurry of good research recently on racial/ethnic differences in end of life care, and I have to say that it's very confusing and seemingly contradictory, which is probably OK, as it's a very complex topic that I don't begin to understand.  Compare these findings to, for instance, Angelo Volandes' research on videos in advance care planning (here and here).  

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