1
|
O'Mahony S, Kittelson S, Barker PC, Delgado Guay MO, Yao Y, Handzo GF, Chochinov HM, Fitchett G, Emanuel LL, Wilkie DJ. Association of Race with End-of-Life Treatment Preferences in Older Adults with Cancer Receiving Outpatient Palliative Care. J Palliat Med 2021; 24:1174-1182. [PMID: 33760658 DOI: 10.1089/jpm.2020.0542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: End-of-life discussions and documentation of preferences are especially important for older cancer patients who are at high risk of morbidity and mortality. Objective: To evaluate influence of demographic factors such as religiosity, education, income, race, and ethnicity on treatment preferences for end-of-life care. Methods: A retrospective observational study was performed on baseline data from a multisite randomized clinical trial of Dignity Therapy in 308 older cancer patients who were receiving outpatient palliative care (PC). Interviews addressed end-of-life treatment preferences, religion, religiosity and spirituality, and awareness of prognosis. End-of-life treatment preferences for care were examined, including preferences for general treatment, cardiopulmonary resuscitation (CPR), and mechanical ventilation (MV). Bivariate associations and multiple logistic regression analysis of treatment preferences with demographic and other baseline variables were conducted. Results: Our regression models demonstrated that race was a significant predictor for CPR preference and preferences for MV, although not for general treatment goals. Minority patients were more likely to want CPR and MV than whites. Men were more likely to opt for MV, although not for CPR or overall aggressive treatment, than women. Higher level of education was a significant predictor for preferences for less aggressive care at the end-of-life but not for CPR or MV. Higher level of terminal illness awareness was also a significant predictor for preferences for CPR, but not MV or aggressive care at the end-of-life. Discussion: Race was significantly associated with all three markers for aggressive care in bivariate analysis and with two out of three markers in multiple regression analysis, with minorities preferring aggressive care and whites preferring less aggressive care. Contrary to our hypothesis, income was not significantly associated with treatment preferences, whereas religion was significantly associated with all markers for aggressive care in bivariate models, but not in multiple regression models. Clinical Trial Registration Number NCT03209440.
Collapse
Affiliation(s)
- Sean O'Mahony
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Paige C Barker
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marvin O Delgado Guay
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingwei Yao
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - George F Handzo
- CSSBB Health Care Chaplaincy Network, New York, New York, USA
| | - Harvey M Chochinov
- Department of Psychiatry, FRSC University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Fitchett
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Linda L Emanuel
- Department of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Diana J Wilkie
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|