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Gallo Marin B, Oliva R, Anandarajah G. Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study. Am J Hosp Palliat Care 2024; 41:508-515. [PMID: 37408485 DOI: 10.1177/10499091231188693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Context: Hospice services are underutilized by the Latino community in the United States. Previous research has identified that language is a key barrier contributing to disparities. However, very few studies have been conducted in Spanish to specifically explore other barriers to hospice enrollment or values related to end-of-life (EOL) care in this community. Here, we remove the language barrier in order to gain an in-depth understanding of what members of the diverse Latino community in one state in the USA considers high quality EOL and barriers to hospice. Methods: This exploratory semi-structured individual interview study of Latino community members was conducted in Spanish. Interviews were audio-recorded, transcribed verbatim and translated to English. Transcripts were analyzed by three researchers, using a grounded-theory approach to identify themes and sub-themes. Main Findings: Six major themes emerged: (1) concept of "a good death"-spiritual peace, family/community connection, no burdens left behind; (2) centrality of family; (3) lack of knowledge about hospice/palliative care; (4) Spanish language as critical; (5) communication style differences; and (6) necessity for cultural understanding. The central theme of "a good death" was closely linked to having the entire family physically and emotionally present. The four other themes represent interrelated, compounding barriers to achieving this "good death." Principal Conclusions: Healthcare providers and the Latino community can work together to decrease hospice utilization disparities by: actively involving family at every step; addressing misconceptions regarding hospice; conducting important conversations in Spanish; and improving provider skills in culturally sensitive care, including communication style.
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Affiliation(s)
| | - Rocío Oliva
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gowri Anandarajah
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Hope Hospice and Palliative Care Rhode Island, Providence, RI, USA
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Lou Y. End-of-life care discussions with healthcare providers and dying experiences: A latent class analysis using the health and retirement study. Arch Gerontol Geriatr 2024; 119:105319. [PMID: 38171033 DOI: 10.1016/j.archger.2023.105319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The impact of provider-patient end-of-life care conversations on the dying experience as a multi-dimensional concept among non-White population is understudied. The study examines whether such discussions are effective at improving end-of-life experiences among U.S. older adults with diverse backgrounds. METHODS The analytic sample featured 9,733 older adults who died between 2002 and 2019 in the Health and Retirement Study. Latent class analysis was used with sixteen end-of-life indicators, including service utilization of seven aggressive and supportive care, symptom management, and quality of care. Multinomial logistic regression was conducted to estimate the effects of provider-patient end-of-life discussions on the predicted membership. RESULTS Three types of end-of-life experiences were identified. People in "minimum service user with good death" (44.54 %) were least likely to use any type of medical care, either aggressive or comforting, and had best end-of-life symptom management and quality of care. Intensive care users (20.70 %) are characterized by very high use of aggressive treatments and low use of supportive care. "Extensive service user with uncomfortable death" (34.76 %) had high likelihoods of using both aggressive and comforting care and had the worst dying experience. Older adults who discussed their end-of-life wishes with providers were 49 % and 51 % more likely to be an intensive care user and extensive service user with uncomfortable death, respectively, rather than a minimum service user with good death. CONCLUSION Discussing end-of-life care wishes with providers is associated with worse end-of-life experiences. Efforts are needed to facilitate early initiation and effectiveness of the provider-patient end-of-life care conversation.
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Affiliation(s)
- Yifan Lou
- School of Medicine, Department of Internal Medicine, Yale University, 300 George, 7th Floor, New Haven, CT 06511, United States.
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3
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Kang JA, Barcelona V. A comparison of conceptual frameworks to examine health inequities in End-of-Life care. J Adv Nurs 2023; 79:2025-2041. [PMID: 35909090 PMCID: PMC9887096 DOI: 10.1111/jan.15393] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
AIMS To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence. DESIGN Discussion paper. DATA SOURCES We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022. IMPLICATIONS FOR NURSING There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health. CONCLUSION We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in end-of-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender. IMPACT Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care. NO PATIENT OR PUBLIC CONTRIBUTION This discussion paper focused on reviewing existing evidence.
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Affiliation(s)
- Jung A Kang
- Columbia University School of Nursing, New York, New York, USA
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4
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Patel NK, Passalacqua SA, Meyer KN, de Erausquin GA. Full Code to Do-Not-Resuscitate: Culturally Adapted Palliative Care Consultations and Code Status Change Among Seriously Ill Hispanic Patients. Am J Hosp Palliat Care 2022; 39:791-797. [PMID: 34467766 DOI: 10.1177/10499091211042305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Palliative care and hospice services are disproportionately underutilized by ethnic minority patients. Addressing barriers to utilization of these services is critical to reducing disparities. The purpose of this study was to assess the impact of a culturally adapted palliative care consultation service for Hispanics on end-of-life decisions, specifically likelihood of changing from full code to do-not-resuscitate (DNR) status during index admission for serious illness. METHODS A cross-sectional study design was applied to data extracted from electronic health records (EHR) of patients seen by a Geriatric Palliative Care service during inpatient stays between 2018 and 2019. The majority of referrals came from critical care sites. Culturally adapted palliative care consultations using the SPIKES tool featured a Spanish-speaking team member leading discussions, involvement of multiple and key family members, and a chaplain who is a Catholic Priest. RESULTS The analytic sample included 351 patients who were, on average, 72 years old. 54.42% were female, 59.54% were Hispanic, and of Hispanic patients, 47.37% spoke primarily Spanish. Culturally adapted consults resulted in higher rates of conversion to DNR status in palliative cases of the target population. Both primary language and ethnicity were associated with likelihood of change from full code to DNR status, such that Spanish speakers and those of Hispanic ethnicity were more likely to switch to DNR than non-Hispanics and English-Speakers. CONCLUSION This study illustrates how culturally adapted palliative care consultations can help reduce barriers and improve end-of-life decision-making, and can be applied with similar populations of seriously ill Hispanic patients.
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Affiliation(s)
- Neela K Patel
- Division of Geriatrics and Supportive Care, Joe R and Teresa Long School of Medicine, 12346University of Texas Health San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Joe and Teresa Long School of Medicine, 12346University of Texas Health San Antonio, TX, USA
| | | | - Kylie N Meyer
- School of Nursing, 14742>UT Health San Antonio, San Antonio, TX, USA
| | - Gabriel A de Erausquin
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Joe and Teresa Long School of Medicine, 12346University of Texas Health San Antonio, TX, USA
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Methods for overcoming barriers in palliative care for ethnic/racial minorities: a systematic review. Palliat Support Care 2020; 17:697-706. [PMID: 31347483 DOI: 10.1017/s1478951519000403] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Ethnic/racial minority groups are less likely to discuss issues involving end-of-life treatment preferences and utilize palliative care or hospice services. Some barriers may be differences in language, religion, lower levels of health literacy, or less access to healthcare services and information. The purpose of this article is to conduct a systematic review on interventional studies that investigated methods to overcome the barriers faced by ethnic/racial minorities when accessing end-of-life services, including completing advanced directives, accepting palliative care, and enrolling in hospice. METHODS Literature searches using four standard scientific search engines were conducted to retrieve articles detailing original research in an interventional trial design. All studies were conducted in an outpatient setting, including primary care visits, home visits, and dialysis centers. Target populations were those identified from ethnic or racial minorities. RESULTS Nine articles were selected to be included in the final review. All were full-text English language articles, with target populations including African Americans, Hispanic or Latinos, and Asian or Pacific Islanders. Measured outcomes involved level of comfort in discussing and knowledge of palliative care services, desire for aggressive care at the end-of-life, completion of advance directives, and rate of enrollment in hospice. SIGNIFICANCE OF RESULTS Three main avenues of interventions included methods to enhance patient education, increase access to healthcare, or improve communication to establish better rapport with target population. Studies indicate that traditional delivery of healthcare services may be insufficient to recruit patients from ethnic/racial minorities, and outcomes can be improved by implementing tailored interventions to overcome barriers.
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Miller JL, Chung ML, Etaee F, Hammash M, Thylén I, Biddle MJ, Elayi SC, Czarapata MM, McEvedy S, Cameron J, Haedtke CA, Ski CF, Thompson DR, Moser DK. Missed opportunities! End of life decision making and discussions in implantable cardioverter defibrillator recipients. Heart Lung 2019; 48:313-319. [DOI: 10.1016/j.hrtlng.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/06/2019] [Accepted: 04/12/2019] [Indexed: 12/29/2022]
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Gao W, Chukwusa E, Verne J, Yu P, Polato G, Higginson IJ. The role of service factors on variations in place of death: an observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Previous studies have revealed that there is significant geographical variation in place of death in (PoD) England, with sociodemographic and clinical characteristics explaining ≤ 25% of this variation. Service factors, mostly modifiable, may account for some of the unexplained variation, but their role had never been evaluated systematically.
Methods
A national population-based observational study in England, using National Death Registration Database (2014) linked to area-level service data from public domains, categorised by commissioning, type and capacity, location and workforce of the services, and the service use. The relationship between the service variables and PoD was evaluated using beta regression at the area level and using generalised linear mixed models at the patient level. The relative contribution of service factors at the area level was assessed using the per cent of variance explained, measured by R2. The total impact of service factors was evaluated by the area under the receiver operating characteristic curve (AUC). The independent effect of service variables was measured at the individual level by odds ratios (ORs).
Results
Among the 431,735 adult deaths, hospitals were the most common PoD (47.3%), followed by care homes (23.1%), homes (22.5%) and hospices (6.1%). One-third (30.3%) of the deaths were due to cancer and two-thirds (69.7%) were due to non-cancer causes. Almost all service categories studied were associated with some of the area-level variation in PoD. Service type and capacity had the strongest link among all service categories, explaining 14.2–73.8% of the variation; service location explained 10.8–34.1% of the variation. The contribution of other service categories to PoD was inconsistent. At the individual level, service variables appeared to be more useful in predicting death in hospice than in hospital or care home, with most AUCs in the fair performance range (0.603–0.691). The independent effect of service variables on PoD was small overall, but consistent. Distance to the nearest care facility was negatively associated with death in that facility. At the Clinical Commissioning Group level, the number of hospices per 10,000 adults was associated with a higher chance of hospice death in non-cancer causes (OR 30.88, 99% confidence interval 3.46 to 275.44), but a lower chance of hospice death in cancer causes. There was evidence for an interaction effect between the service variables and sociodemographic variables on PoD.
Limitations
This study was limited by data availability, particularly those specific to palliative and end-of-life care; therefore, the findings should be interpreted with caution. Data limitations were partly due to the lack of attention and investment in this area.
Conclusion
A link was found between service factors and PoD. Hospice capacity was associated with hospice death in non-cancer cases. Distance to the nearest care facility was negatively correlated with the probability of a patient dying there. Effect size of the service factors was overall small, but the interactive effect between service factors and sociodemographic variables suggests that high-quality end-of-life care needs to be built on service-level configuration tailored to individuals’ circumstances.
Future work
A large data gap was identified and data collection is required nationally on services relevant to palliative and end-of-life care. Future research is needed to verify the identified links between service factors and PoD.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Julia Verne
- Knowledge and Intelligence (South West), National End of Life Care Intelligence Network, Public Health England, Bristol, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Giovanna Polato
- Monitoring Analytics (Mental Health, Learning Disability and Substance Misuse), Care Quality Commission, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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8
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Gao W, Huque S, Morgan M, Higginson IJ. A Population-Based Conceptual Framework for Evaluating the Role of Healthcare Services in Place of Death. Healthcare (Basel) 2018; 6:E107. [PMID: 30200247 PMCID: PMC6164352 DOI: 10.3390/healthcare6030107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is a significant geographical disparity in place of death. Socio-demographic and disease-related variables only explain less than a quarter of the variation. Healthcare service factors may account for some (or much) of the remaining variation but their effects have never been systematically evaluated, partly due to the lack of a conceptual framework. This study aims to propose a population-based framework to guide the evaluation of the role of the healthcare service factors in place of death. METHODS Review and synthesis of health service models that include the impact of a service component on either place of death/end of life care outcomes or service access/utilization. RESULTS The framework conceptualizes the impact of healthcare services on the place of death as starting from the end of life care policies that in turn influence service commissioning and shape healthcare service characteristics, including service type, service capacity-facilities, service location, and workforce, through which service utilization and ultimately place of death are affected. Patient socio-demographics, disease-related variables, family and community support and social care also influence place of death, but they are not the focus of this framework and therefore are grouped as needs and other environmental factors. Information on service utilization, together with the place of death, creates loop feedback to inform policy and service commission. CONCLUSIONS The framework provides guidance for analysis aiming to understand the role of healthcare services in place of death. It aids the interpretation of results in the light of existing knowledge and potentially identifies service factors that can be addressed to improve end of life care.
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Affiliation(s)
- Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
| | - Sumaya Huque
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK.
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
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Delgado-Guay MO, Ferrer J, Ochoa J, Cantu H, Williams JL, Park M, Bruera E. Characteristics and Outcomes of Advanced Cancer Patients Who Received Palliative Care at a Public Hospital Compared with Those at a Comprehensive Cancer Center. J Palliat Med 2018; 21:678-685. [PMID: 29451835 DOI: 10.1089/jpm.2017.0236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with advanced cancer experience severe physical, psychosocial, and spiritual distress requiring palliative care (PC). There are limited literature regarding characteristics and outcomes of patients evaluated by PC services at public hospitals (PHs). Objective, Design, Setting/Subjects, and Measurements: To compare the outcomes of advanced cancer patients undergoing PC at a PH and those at a comprehensive cancer center (CCC). We reviewed 359 consecutive advanced cancer patients (PH, 180; CCC, 179) undergoing PC. Symptoms and outcomes at consultation and first follow-up visit were assessed. Summary statistics were used to describe patient characteristics and outcomes. RESULTS The PH and CCC patients differed significantly according to race: 23% white, 39% black, and 36% Hispanic patients at the PH versus 66% white, 17% black, and 11% Hispanic patients at the CCC (p < 0.0001). Ninety-six (53%) patients at PH and 178 (99%) at the CCC had health insurance (p < 0.0001). Symptoms at consultation at PH and CCC were pain (85% and 91%, respectively; p = 0.0639), fatigue (81% and 94%, respectively; p = 0.0003), depression (51% and 69%, respectively; p = 0.0013), anxiety (47% and 75%, respectively; p < 0.0001), and well-being (63% and 93%, respectively; p < 0.0001). Multiple interventions provided: opioids, reviews for polypharmacy, constipation management, and interdisciplinary counseling. Median time from outpatient consultation to follow-up was 29 days(range, 1-119 days) at the PH and 21 days (range, 1-275 days) at the CCC (p = 0.0006). Median overall survival time from outpatient consultation was 473 days (95% confidence interval [CI], 205-699 days) at PH and 245 days (95% CI, 152-491 days) at CCC (p = 0.3408). CONCLUSIONS Advanced cancer patients at both institutions frequently had multiple distressing physical and emotional symptoms, although the frequency was higher at CCC. The median overall survival duration was higher at the PH. More research is needed.
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Affiliation(s)
- Marvin Omar Delgado-Guay
- 1 Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Jeannette Ferrer
- 2 Division of Geriatrics and Palliative Medicine, The University of Texas Health Science Center at Houston , McGovern Medical School, Harris Health System, Lyndon B. Johnson Hospital, Houston, Texas
| | - Jewel Ochoa
- 1 Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Hilda Cantu
- 1 Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Janet L Williams
- 1 Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Minjeong Park
- 3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Eduardo Bruera
- 1 Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
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Wang X, Knight LS, Evans A, Wang J, Smith TJ. Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer. J Oncol Pract 2017; 13:e496-e504. [PMID: 28221897 DOI: 10.1200/jop.2016.018093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. METHODS We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. RESULTS Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. CONCLUSION Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.
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Affiliation(s)
- Xiao Wang
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Louise S Knight
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Anne Evans
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Jiangxia Wang
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
| | - Thomas J Smith
- The Johns Hopkins University School of Medicine; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Hospital, Baltimore; and Gilchrist Services, Hunt Valley, MD
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Fang ML, Sixsmith J, Sinclair S, Horst G. A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review. BMC Geriatr 2016; 16:107. [PMID: 27193395 PMCID: PMC4872365 DOI: 10.1186/s12877-016-0282-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
Background Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. Methods To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014. Results The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making. Conclusions This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0282-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mei Lan Fang
- Gerontology Research Centre, Simon Fraser University, 2800-515 West Hastings Street, Vancouver, BC, V6B 5 K3, Canada.
| | - Judith Sixsmith
- Institute of Health and Wellbeing, University of Northampton, Northampton, UK.,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
| | - Glen Horst
- Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
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Choi HA, Fernandez A, Jeon SB, Schmidt JM, Connolly ES, Mayer SA, Claassen J, Badjatia N, Prager KM, Lee K. Ethnic disparities in end-of-life care after subarachnoid hemorrhage. Neurocrit Care 2016; 22:423-8. [PMID: 25501687 DOI: 10.1007/s12028-014-0073-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is common for patients who die from subarachnoid hemorrhage to have a focus on comfort measures at the end of life. The potential role of ethnicity in end-of-life decisions after brain injury has not been extensively studied. METHODS Patients with subarachnoid hemorrhage were prospectively followed in an observational database. Demographic information including ethnicity was collected from medical records and self-reported by patients or their family. Significant in-hospital events including do-not-resuscitate orders, comfort measures only orders (CMO; care withheld or withdrawn), and mortality were recorded prospectively. RESULTS 1255 patients were included in our analysis: 650 (52 %) were White, 387 (31 %) Hispanic, and 218 (17 %) Black. Mortality was similar between the groups. CMO was more commonly observed in Whites (14 %) compared to either Blacks (10 %) or Hispanics (9 %) (p = 0.04). In a multivariate analysis controlling for age and Hunt-Hess grade, Hispanics were less likely to have CMO than Whites (OR, 0.6; 95 %CI, 0.4-0.9; p = 0.02). Of the 229 patients who died, 77 % of Whites had CMO compared to 54 % of Blacks and 49 % of Hispanics (p < 0.01). In a multivariate analysis, Blacks (OR, 0.3; 95 %CI, 0.2-0.7; p < 0.01) and Hispanics (OR, 0.3; 95 %CI, 0.2-0.6; p < 0.01) were less likely to die with CMO orders than Whites. CONCLUSION After subarachnoid hemorrhage, Blacks and Hispanics are less likely to die with CMO orders than Whites. Further research to confirm and investigate the causes of these ethnic differences should be performed.
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Affiliation(s)
- H Alex Choi
- Departments of Neurosurgery and Neurology, The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 7.154, Houston, TX, 77030, USA,
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Sharma RK, Cameron KA, Chmiel JS, Von Roenn JH, Szmuilowicz E, Prigerson HG, Penedo FJ. Racial/Ethnic Differences in Inpatient Palliative Care Consultation for Patients With Advanced Cancer. J Clin Oncol 2015; 33:3802-8. [PMID: 26324373 DOI: 10.1200/jco.2015.61.6458] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Inpatient palliative care consultation (IPCC) may help address barriers that limit the use of hospice and the receipt of symptom-focused care for racial/ethnic minorities, yet little is known about disparities in the rates of IPCC. We evaluated the association between race/ethnicity and rates of IPCC for patients with advanced cancer. PATIENTS AND METHODS Patients with metastatic cancer who were hospitalized between January 1, 2009, and December 31, 2010, at an urban academic medical center participated in the study. Patient-level multivariable logistic regression was used to evaluate the association between race/ethnicity and IPCC. RESULTS A total of 6,288 patients (69% non-Hispanic white, 19% African American, and 6% Hispanic) were eligible. Of these patients, 16% of whites, 22% of African Americans, and 20% of Hispanics had an IPCC (overall P < .001). Compared with whites, African Americans had a greater likelihood of receiving an IPCC (odds ratio, 1.21; 95% CI, 1.01 to 1.44), even after adjusting for insurance, hospitalizations, marital status, and illness severity. Among patients who received an IPCC, African Americans had a higher median number of days from IPCC to death compared with whites (25 v 17 days; P = .006), and were more likely than Hispanics (59% v 41%; P = .006), but not whites, to be referred to hospice. CONCLUSION Inpatient settings may neutralize some racial/ethnic differences in access to hospice and palliative care services; however, irrespective of race/ethnicity, rates of IPCC remain low and occur close to death. Additional research is needed to identify interventions to improve access to palliative care in the hospital for all patients with advanced cancer.
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Affiliation(s)
- Rashmi K Sharma
- Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
| | - Kenzie A Cameron
- Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Joan S Chmiel
- Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Jamie H Von Roenn
- Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Eytan Szmuilowicz
- Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Holly G Prigerson
- Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
| | - Frank J Penedo
- Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY
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