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Ethnicity, race, and advance directives in an inpatient palliative care consultation service

Published online by Cambridge University Press:  06 July 2012

Glenn B. Zaide ,
Renee Pekmezaris ,
Christian N. Nouryan ,
Tanveer P. Mir ,
Cristina P. Sison ,
Tara Liberman ,
Martin L. Lesser ,
Lynda.B. Cooper  and
Gisele P. Wolf-Klein
Glenn B. Zaide
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Renee Pekmezaris*
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York Feinstein Institute for Medical Research, Manhasset, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
Christian N. Nouryan
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Tanveer P. Mir
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Cristina P. Sison
Affiliation:
Feinstein Institute for Medical Research, Manhasset, New York
Tara Liberman
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Martin L. Lesser
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York Feinstein Institute for Medical Research, Manhasset, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
Lynda.B. Cooper
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Gisele P. Wolf-Klein
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
*
Address correspondence and reprint requests to: Renee Pekmezaris, North Shore-LIJ Health System, 175 Community Dr., Great Neck, NY 11021. E-mail: [email protected]
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Abstract

Objective:

Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).

Method:

A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).

Results:

Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.

Significance of results:

This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.

Keywords

PCCEnd of lifeAdvance directiveRaceEthnicityDNRDNI
Type
Original Articles
Information
Palliative & Supportive Care , Volume 11 , Issue 1 , February 2013 , pp. 5 - 11
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

Alano, G.J., Pekmezaris, R., Tai, J.Y., et al. (2010). Factors influencing older adults to complete advance directives. Palliative & Supportive Care, 8, 267–275.CrossRefGoogle ScholarPubMed
Bullock, K. (2011). The influence of culture on end-of-life decision making. Journal of Social Work in End-of-Life and Palliative Care, 7, 83–98.CrossRefGoogle ScholarPubMed
Dobalian, A. (2006). Advance care planning documents in nursing facilities: results from a nationally representative survey. Archives of Gerontology and Geriatrics, 43, 193–212.CrossRefGoogle ScholarPubMed
Johnson, K.S., Kuchibhatla, M. & Tulsky, J.A. (2008). What explains racial differences in the use of advance directives and attitudes toward hospice care? Journal of the American Geriatrics Society, 56, 1953–1958.Google Scholar
Kelley, A.S. & Meier, D.E. (2010). Palliative care – A shifting paradigm. New England Journal of Medicine, 363, 781–782.Google Scholar
Kiely, O.K., Mitchell, S.L., Marlow, A., et al. (2001). Racial and state differences in the designation of advance directives in nursing home residents. Journal of the American Geriatrics Society, 49, 1346–1352.CrossRefGoogle ScholarPubMed
Kwak, J. & Haley, W. (2005). Current research findings on end-of-life decision making among racially or ethnically diverse groups. Gerontologist, 45, 634–641.Google Scholar
Levin, T.T., Li, Y., Weiner, J.S., et al. (2008). How do-not-resuscitate orders are utilized in cancer patients: Timing relative to death and communication-training implications. Palliative & Supportive Care, 6, 341–348.CrossRefGoogle ScholarPubMed
Liao, Y., Bang, D., Cosgrove, S., et al. (2011). Surveillance of health status in minority communities – Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Surveillance Summaries, 60, 1–44.Google Scholar
Loggers, E.T., Maciejewski, P.K., Paulk, E., et al. (2009). Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. Journal of Clinical Oncology, 27, 5559–5564.Google Scholar
Mack, J.W., Paulk, M.E., Viswanath, K., et al. (2010). Racial disparities in the outcomes of communication on medical care received near death. Archives of Internal Medicine, 170, 1533–1540.Google Scholar
Mebane, E.W., Oman, R.F., Kroonen, L.T., et al. (1999). The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making. Journal of the American Geriatrics Society, 47, 579–591.CrossRefGoogle ScholarPubMed
Muni, S., Engleberg, R.A., Treece, P.D., et al. (2011). The influence of race/ethnicity and socioeconomic status on end–of-life care in the ICU. Chest, 139,1025–1033.CrossRefGoogle Scholar
O'Mahony, S., McHenry, J., Blank, A.E., et al. (2010). Preliminary report of the integration of a palliative care team into an intensive care unit. Palliative Medicine, 24, 154–165.Google Scholar
Parsons, H.A., de la Cruz, M.J., Zhukovsky, D.S., et al. (2010). Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center. Cancer, 116, 3061–3070.Google Scholar
Pekmezaris, R., Cooper, L., Efferen, L., et al. (2010). Transforming the mortality review conference to assess palliative care in the acute care setting: A feasibility study. Palliative & Supportive Care, 8, 421–426.CrossRefGoogle ScholarPubMed
Perkins, H.S., Geppert, C.M.A., Gonzales, A., et al. (2002). Cross-cultural similarities and differences in attitudes about advance care planning. Journal of General Internal Medicine, 17, 48–57.CrossRefGoogle ScholarPubMed
Physician Orders for Life-Sustaining Treatment Paradigm (POLST). (2011). http://www.ohsu.edu/polst/.Google Scholar
Sabatino, C.P. (2010). The evolution of health care advance planning law and policy. The Milbank Quarterly, 88, 211–239.Google Scholar
Searight, H.R. & Gafford, J. (2005). Cultural diversity at the end of life: Issues and guidelines for family physicians. American Family Physician, 71, 515–522.Google ScholarPubMed
Seckler, A.B., Meier, D.E., Mulvihill, M., et al. (1991). Substituted judgment: How accurate are proxy predictions? Annals of Internal Medicine, 115, 92–98.Google Scholar
Shalowitz, D.I., Garrett-Mayer, E. & Wendler, D. (2006). The accuracy of surrogate decision makers: A systematic review. Archives of Internal Medicine, 166, 493–497.CrossRefGoogle ScholarPubMed
Smith, A.K., McCarthy, E.P., Paulk, E., et al. (2008). Racial and ethnic differences in advance care planning among patients with cancer: Impact of terminal illness acknowledgment, religiousness, and treatment preferences. Journal of Clinical Oncology, 26, 4131–4137.CrossRefGoogle ScholarPubMed
Stone, J. (1994). Advance directives, autonomy and unintended death. Bioethics, 8, 223–246.CrossRefGoogle ScholarPubMed
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New Englang Journal of Medicine, 363, 733–742.Google Scholar
United States Census Bureau. (2000). Racial and ethnic classifications used in census 2000 and beyond. http://www.census.gov/population/www/socdemo/race/racefactcb.html.Google Scholar
Wallace, M.P., Weiner, J.S., Pekmezaris, R., et al. (2007). Physician cultural sensitivity in African American advance care planning: A pilot study. Journal of Palliative Medicine, 10, 721–727.CrossRefGoogle ScholarPubMed
Wilkinson, A., Wenger, N. & Shugarman, L.R. (2007). Literature review on advance directives. http://aspe.hhs.gov/daltcp/reports/2007/advdirlr.pdf.Google Scholar