Preferences for More Aggressive End-of-life Pharmacologic Care Among Racial Minorities in a Large Population-Based Cohort of Cancer Patients.
Preferences for More Aggressive End-of-life Pharmacologic Care Among Racial Minorities in a Large Population-Based Cohort of Cancer Patients.
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DOI：
10.1016/j.jpainsymman.2021.02.001
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发表时间：
2021-09
影响因子：
4.7
通讯作者：
Guadagnolo BA
中科院分区：
文献类型：
--
作者：
Boyce-Fappiano D;Liao K;Miller C;Peterson SK;Elting L;Guadagnolo BA
少数患者在生命结束时（EOL）接受更积极和潜在的次优护理。我们调查了最近诊断的癌症患者在EOL时对药物干预的偏好及其受社会人口因素影响的潜在变化。在2018年3月至2020年6月期间，使用多尺度库存对通过德克萨斯州癌症登记处确定的癌症患者进行了基于人群的横断面调查。本研究的重点是对EOL时潜在药理学干预问题的项目回答。逆概率加权多变量分析研究了社会人口学特征，健康素养和信任医疗专业人员与药理学偏好的关系。在1480份回复中，13.3%的人表示他们会以感觉更糟为代价服用可能延长生命的药物。调整后的分析显示，黑人或西班牙裔种族/民族，与另一个人生活在一起，并且具有更高的信任分数更有可能表达这种偏好。相比之下，41- 65岁（与21- 40岁），生活在农村地区，以及足够或未知的健康素养不太可能表达这种偏好。总体而言，16%的受访者反对可能缩短寿命的姑息药物。在调整后的分析中，黑人或西班牙裔受访者更有可能反对可能缩短寿命的药物，而年龄65-79岁和≥大学教育与反对该项目的可能性降低相关。黑人和西班牙裔癌症患者更可能表达对更积极的EOL药物治疗的偏好。这些发现独立于其他社会人口特征，健康素养和对医学专业的信任。
Minority patients receive more aggressive and potentially suboptimal care at the end of life (EOL). We investigated preferences about pharmacologic interventions at the EOL and their potential variation by socio-demographic factors among recently diagnosed cancer patients. A population-based cross-sectional survey of cancer patients identified through the Texas Cancer registry was conducted using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about potential pharmacologic interventions at the EOL were the focus of this investigation. Inverse probability weighted multivariate analysis examined associations of socio-demographic characteristics, health literacy, and trust in medical professionals with pharmacologic preferences. Of the 1480 included responses, 13.3% stated they would take a medication that may prolong life at the cost of feeling worse. Adjusted analyses showed Black or Hispanic race/ethnicity, living with another person, and having a higher trust score were more likely to express this preference. In contrast, 41–65y (vs. 21–40y), living in a rural area, and adequate or unknown health literacy were less likely to express this preference. Overall 16% of respondents were opposed to potentially life shortening palliative drugs. In adjusted analysis Black or Hispanic respondents were more likely to be opposed to potentially life shortening drugs while age 65–79 and ≥ college education were associated with a decreased likelihood of opposition to this item. Black and Hispanic cancer patients were more likely to express preferences toward more aggressive EOL pharmacologic care. These findings were independent of other sociodemographic characteristics, health literacy and trust in the medical profession.
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