The effects of patient race on outcomes in seriously ill patients in SUPPORT: An overview of economic impact, medical intervention, and end-of-life decisions
The effects of patient race on outcomes in seriously ill patients in SUPPORT: An overview of economic impact, medical intervention, and end-of-life decisions
复制标题
DOI：
10.1111/j.1532-5415.2000.tb03132.x
复制
发表时间：
2000-05-01
影响因子：
6.3
通讯作者：
Zhong, ZS
中科院分区：
文献类型：
--
作者：
Borum, ML;Lynn, J;Zhong, ZS
背景：美国黑人的预期寿命明显低于美国白人。种族差异在医疗获取、管理和DNR订单方面已被记录在案。目的：在了解预后和治疗结果和风险偏好的研究中，回顾患者种族对重症患者干预和临终决定的影响（支持）。设计：回顾SUPPORT发表的分析。环境：5家教学医院参与者：共9105名18岁或以上的患者（15%为黑人）符合诊断和疾病严重程度标准。测量：分析通过图表抽象和访谈收集的数据。结果：黑人报告了储蓄的显著损失，尽管根据诊断和疾病严重程度调整后没有显示出显著的种族差异。经济困难与对舒适护理的偏好相关，黑人患者除外（OR 0.71; CI 95%, 0.57-0.88）。黑人接受的干预较少，但存活率没有显著差异。疼痛程度和控制不受种族的影响。黑人更有可能想要心肺复苏术，尽管自我支付或医疗补助的调整消除了种族差异。黑人在住院2个月后更有可能继续选择心肺复苏术（28%对17%），更有可能改变DNR命令，选择心肺复苏术（40%对27%）。黑人也更频繁地希望与医生讨论心肺复苏术的偏好，但很少有这种类型的交流（OR 1.53; CI 95%, 1.11-2.11）。结论：患者种族可能影响重症患者的医疗干预和偏好。然而，在这个人群中，这些差异的临床重要性并不大。
BACKGROUND: Black Americans have significantly lower life expectancy than white Americans. Racial differences in medical access, management, and DNR orders have been documented.OBJECTIVE: To review the effects of patient race on intervention and end-of-life decisions in seriously ill patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).DESIGN: Review of published analyses from SUPPORT.SETTING: Five teaching hospitalsPARTICIPANTS: A total of 9105 patients aged 18 years or older (15% black race) meeting diagnostic and illness severity criteria.MEASUREMENT: Analysis of data collected by chart abstraction and interviews.RESULTS: Blacks reported significant loss in savings, although adjusting for diagnosis and disease severity did not demonstrate significant racial differences. Economic hardship was associated with a preference for comfort care, except in black patients (OR 0.71; CI 95%, 0.57-0.88). Blacks received less intervention with no significant difference in survival. Pain level and control were not affected by race. Blacks were more likely to want CPR, although adjustment for self-pay or Medicaid eliminated racial differences. Blacks were more likely to continue to prefer CPR 2 months after hospitalization (28% vs 17%) and were more likely to change a DNR order to preferring CPR (40 vs 27%). Blacks also more frequently wished to discuss CPR preferences with their physicians but were less likely to have this type of communication (OR 1.53; CI 95%, 1.11-2.11).CONCLUSIONS: Patient race may impact on medical intervention and preferences in seriously ill patients. However, in this population, the differences are of modest clinical importance.