Racial disparities in the outcomes of communication on medical care received near death.
Racial disparities in the outcomes of communication on medical care received near death.
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DOI：
10.1001/archinternmed.2010.322
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发表时间：
2010-09-27
影响因子：
--
通讯作者：
Prigerson, Holly G.
中科院分区：
文献类型：
--
作者：
Mack, Jennifer W.;Paulk, M. Elizabeth;Viswanath, Kasisomayajula;Prigerson, Holly G.
黑人患者往往比白色患者在生命结束时接受更多的延长生命的护理。本研究旨在评估患者与医生沟通的差异是否会导致EOL护理中的黑白差异。261例白色和71例黑人晚期癌症患者的多机构前瞻性纵向队列研究。主要结局指标为EOL讨论、沟通目标（终末期疾病意识、治疗偏好、DNR订单）和EOL护理结局（延长生命护理、临终关怀、接受与偏好一致的护理）之间关系的黑白差异。医生和他们的白色患者之间的终末期讨论与延长生命的终末期护理较少相关（调整后的比值比（AOR）0.11，P= 0.04）。然而，黑人患者接受延长生命护理的比例高于白色患者（20% vs 7%，P= 0.001），尽管EOL讨论的比例相似（35% vs 38%，P= 0.65）。EOL讨论与黑人之间的一些沟通目标的实现相关，包括DNR订单的放置（AOR 4.25，P=.04），但这些沟通目标与黑人患者接受的EOL护理并不一致。例如，有DNR命令的黑人患者接受延长生命护理的可能性不低于没有DNR命令的黑人（AOR 1.57，P=.58）。EOL讨论和沟通目标似乎有助于白色患者在EOL时接受较少的延长生命护理。然而，黑人患者没有体验到EOL讨论的相同益处。相反，黑人患者倾向于在EOL时接受延长生命的措施，即使他们有DNR命令或声明偏好非正规护理。
Black patients tend to receive more life-prolonging care at the end of life (EOL) than White patients. This study aimed to evaluate whether differences in patient-physician communication contribute to Black-White disparities in EOL care. Multi-institutional prospective longitudinal cohort study of 261 White and 71 Black advanced cancer patients. Main outcome measures were Black-White differences in relationships between EOL discussions, communication goals (terminal illness awareness, treatment preferences, DNR orders), and EOL care outcomes (life-prolonging care, hospice care, receipt of care consistent with preferences). EOL discussions between physicians and their White patients were associated with less life-prolonging EOL care (adjusted odds ratio (AOR) .11, P=.04). However, more Black patients than White patients received life-prolonging care (20% versus 7%, P=.001) despite similar rates of EOL discussions (35% versus 38%, P=.65). EOL discussions were associated with attainment of some communication goals among Blacks, including placement of DNR orders (AOR 4.25, P=.04), but these communication goals were not consistently associated with EOL care received by Black patients. For example, Black patients with DNR orders were no less likely than Blacks without DNR orders to receive life-prolonging care (AOR 1.57, P=.58). EOL discussions and communication goals appear to assist White patients in receiving less life-prolonging care at the EOL. Black patients, however, do not experience the same benefits of EOL discussions. Instead, Black patients tend to receive life-extending measures at the EOL even when they have DNR orders or state a preference for symptom-directed care.
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影响因子：
120.7
作者：
Phelps, Andrea C.;Maciejewski, Paul K.;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
DOI：
10.1046/j.1365-2389.2003.51310.x
发表时间：
2003-07-01
影响因子：
6.3
作者：
Greiner, KA;Perera, S;Ahluwalia, JS
通讯作者：
Ahluwalia, JS
影响因子：
--
作者：
Johnson, Kimberly S.;Kuchibhatla, Maragatha;Tulsky, James A.
通讯作者：
Tulsky, James A.
麦吉尔生活质量问卷--适合晚期疾病患者的生活质量测量方法--有效性和可接受性初步研究
影响因子：
4.4
作者：
COHEN, SR;MOUNT, BM;BUI, F
通讯作者：
BUI, F
DOI：
10.1111/j.1532-5415.2000.tb03132.x
发表时间：
2000-05-01
影响因子：
6.3
作者：
Borum, ML;Lynn, J;Zhong, ZS
通讯作者：
Zhong, ZS