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Race affects hospice use in terminal cancer patients
Recent research indicates that blacks and Asians with terminal cancer use end-of-life services less frequently than do whites and Hispanics.
The researchers studied the records of 41,000 terminal cancer Medicare patients over age 65, according to senior author Ellen McCarthy, PhD, of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center (BIDMC).
After accounting for a number of other factors, including income and physical health, their findings showed that compared with whites and Hispanics, black and Asian patients were more likely to be hospitalized frequently, to be hospitalized for prolonged periods, to receive care in an intensive care unit (ICU), and to die in the hospital. Compared with the other patients, black patients were 9% less likely to enroll in a hospice program, and Asian Americans were 24% less likely to do so. Those same two population groups also were 26% and 17% more likely, respectively, to be hospitalized in the intensive care unit at least twice during their last month of life.
The study's lead author Alexander Smith, MD, a former fellow in the Division of General Medicine and Primary Care at BIDMC, said, "Going forward, it will be important to find out whether patients' personal preferences, unequal access to health care, or both are fueling racial differences in end-of-life care. Minority patients may be bearing the burdens of high-intensity care at the end of life, without realizing the benefits of hospice and palliative care."
Adds McCarthy, "In order to develop effective strategies to promote hospice and palliative care services for these underserved populations, further research is needed to clarify the extent to which racial and ethnic differences in end-of-life care are due to cultural factors vs. inequities."
The study was published in the January 2009 issue of the Journal of the American Geriatrics Society (JAGS).