Racial Disparities Found In New Study On End-Of-Life Care

Adherence to patient preferences in end-of-life care decisions was less likely to be observed for that of black cancer patients than for the preferences of white cancer patients, according to research from the Dana Farber Cancer Institute.

"None of the white patients who reported the completion of a do-not-resuscitate order, or DNR, at baseline subsequently received intensive care in the last week of life," said Holly Prigerson, PhD, senior author of the report published in the Journal of Clinical Oncology. "This did not prove to be the case for black patients. DNR orders did not significantly protect black patients from intensive end-of-life care in this study."

Interviews were conducted with 234 white patients and 68 black patients with advanced cancer about their preferences for end-of-life care, their trust in their physicians, end-of-life discussions with their doctor, and the completion of DNR orders.

Based on the initial interviews, the patients were similar in their trust of physicians and having an end-of-life discussion with them.

It was shown that blacks tended to prefer intensive end-of-life care, were less likely to report that a DNR order was completed for them, and were more likely to put their faith in religion.

However, researchers said none of these factors explain the disparities. "Instead it appears that ‘social forces’ such as disruptions in continuity of care and cultural differences that impaired patient-physician communication, might be to blame," said the report.

In a few instances when DNR forms were completed for black patients, informal caregivers may have changed over the course of their illness, and treatment hospitals providing care may have also changed. It is because of these changes that researchers believe preferences were not as clear, and may have been lost in the gaps of communication.

"Enhanced communication would help to ensure that patients appreciate the risks and benefits of intensive care and that the providers are better informed of their patients’ wishes," said Prigerson.

Address: Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115; (617) 632-3000, www.dana-farber.org.

Hospice Rate And Productivity Analysis From The NHPCO
Effective Date	Hospital Market Basket Index	Rate W/O Cuts	BNAF Cuts	Rate W/BNAF Cut	Rate Post BNAF Cut Only	Productivity Factor (est.)	Rate W/Prod. Factor Cut	Rate Post Prod. Factor Cut Only	Rate W/BNAF Cut And Prod. Factor Cut	Rate Post BNAF Cut and Prod. Factor Cut
10/1/19	*2.4%	$181.11		$176.01	-2.8%	1.6%	$159.66	-11.8%	$155.13	-14.3%
10/1/18	*2.4%	$176.91		$171.94	-2.8%	1.6%	$158.44	-10.4%	$153.94	-13.0%
10/1/17	*2.4%	$172.82		$167.96	-2.8%	1.6%	$157.23	-7.6%	$152.77	-11.6%
10/1/16	*2.4%	$168.82		$164.07	-2.8%	1.6%	$156.03	-6.1%	$151.60	-10.2%
10/1/15	*2.4%	$164.91	0.6%	$160.27	-2.8%	1.6%	$154.84	-4.6%	$150.44	-8.8%
10/1/14	*2.4%	$161.09	0.6%	$157.23	-2.4%	1.6%	$153.66	-3.1%	$149.94	-6.9%
10/1/13	*2.4%	$157.36	0.6%	$154.25	-2.0%	1.6%	$152.48	-1.6%	$149.44	-5.0%
10/1/12	*2.4%	$153.72	0.6%	$151.32	-1.6%	1.6%	$151.32	0.0%	$148.95	-3.1%
10/1/11	*2.4%	$150.16	0.6%	$148.46	-1.1%		$150.16	0.0%	$148.46	-1.1%
10/1/10	*2.4%	$146.68	0.6%	$145.64	-0.7%		$146.68	0.0%	$145.64	-0.7%
10/1/09	2.4%	$143.29	0.4%	$142.88	-0.3%		$143.29	0.0%	$142.88	-0.3%

Note: *Estimate
Source: National Hospice and Palliative Care Organization.