End-of-life care in black and white: Race matters for medical care of dying patients and their families

Lisa C. Welch, Joan Teno, Vincent Mor

Research output: Contribution to journalReview article

133 Citations (Scopus)

Abstract

OBJECTIVES: To compare the end-of-life medical care experienced by African-American and white decedents and their families. DESIGN: Cross-sectional, retrospective survey with weighted results based on a two-stage probability sampling design. SETTING: Hospitals, nursing homes, and home-based medical services across the United States. PARTICIPANTS: Surrogates (N = 1,447; primarily family members) for decedents from 22 states. MEASUREMENTS: Validated end-of-life care outcomes concerning symptom management, decision-making, informing and supporting families, individualized care, coordination, service utilization, and financial impact. RESULTS: Family members of African-American decedents were less likely than those of white decedents to rate the care received as excellent or very good (odds ratio (OR) = 0.4). They were more likely to report absent (OR = 2.4) or problematic (OR = 1.9) physician communication, concerns with being informed (OR = 2.5), and concerns with family support (OR = 2.6). Family members of African Americans were less likely than those of whites to report that the decedent had treatment wishes (OR = 0.3) or written advance care planning documents (OR = 0.4). These differences persist when limiting the sample to respondents whose expectations for life-sustaining treatments matched treatments received. Family members of African-American decedents also were more likely to report financial hardship due to savings depletion (OR = 2.1) or difficulty paying for care (OR = 2.0) and that family/friends (OR = 2.0) or home health workers (OR = 1.9) provided home care. CONCLUSION: This national study brings evidence that racial disparities persist into end-of-life care, particularly regarding communication and family needs. Results also suggest different home care patterns and levels of financial impact.

Original languageEnglish (US)
Pages (from-to)1145-1153
Number of pages9
JournalJournal of the American Geriatrics Society
Volume53
Issue number7
DOIs
StatePublished - Jul 1 2005
Externally publishedYes

Fingerprint

Terminal Care
Patient Care
Odds Ratio
African Americans
Home Care Services
White Matter
hydroquinone
Advance Care Planning
Communication
Patient-Centered Care
Nursing Homes
Decision Making
Therapeutics
Cross-Sectional Studies
Physicians

Keywords

  • Disparity
  • Dying
  • End-of-life care
  • Quality of care
  • Race

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

End-of-life care in black and white : Race matters for medical care of dying patients and their families. / Welch, Lisa C.; Teno, Joan; Mor, Vincent.

In: Journal of the American Geriatrics Society, Vol. 53, No. 7, 01.07.2005, p. 1145-1153.

Research output: Contribution to journalReview article

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abstract = "OBJECTIVES: To compare the end-of-life medical care experienced by African-American and white decedents and their families. DESIGN: Cross-sectional, retrospective survey with weighted results based on a two-stage probability sampling design. SETTING: Hospitals, nursing homes, and home-based medical services across the United States. PARTICIPANTS: Surrogates (N = 1,447; primarily family members) for decedents from 22 states. MEASUREMENTS: Validated end-of-life care outcomes concerning symptom management, decision-making, informing and supporting families, individualized care, coordination, service utilization, and financial impact. RESULTS: Family members of African-American decedents were less likely than those of white decedents to rate the care received as excellent or very good (odds ratio (OR) = 0.4). They were more likely to report absent (OR = 2.4) or problematic (OR = 1.9) physician communication, concerns with being informed (OR = 2.5), and concerns with family support (OR = 2.6). Family members of African Americans were less likely than those of whites to report that the decedent had treatment wishes (OR = 0.3) or written advance care planning documents (OR = 0.4). These differences persist when limiting the sample to respondents whose expectations for life-sustaining treatments matched treatments received. Family members of African-American decedents also were more likely to report financial hardship due to savings depletion (OR = 2.1) or difficulty paying for care (OR = 2.0) and that family/friends (OR = 2.0) or home health workers (OR = 1.9) provided home care. CONCLUSION: This national study brings evidence that racial disparities persist into end-of-life care, particularly regarding communication and family needs. Results also suggest different home care patterns and levels of financial impact.",
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