Race, ethnicity, and goal-concordance of end-of-life palliative care in pediatric oncology.
Race, ethnicity, and goal-concordance of end-of-life palliative care in pediatric oncology.
复制标题
儿科肿瘤学临终姑息治疗的种族、民族和目标一致性。
作者：
Umaretiya,PujaJ;Li,Anran;McGovern,Alana;Ma,Clement;Wolfe,Joanne;Bona,Kira
患有癌症的少数民族和少数族裔儿童在生命末期（EOL）接受重症监护的比例过高。目前尚不清楚这些差异是目标一致还是差异。作者试图探索儿科姑息治疗（PPC）模式和在生命末期接受亚专科姑息治疗的儿科肿瘤患者的医疗保健利用（过去6个月）方法：这是一项回顾性队列研究，研究对象是在一个大型三级医疗中心接受亚专科姑息治疗的儿科肿瘤患者，2013年1月和2017年3月，共有115例TSA患者（包括71例白色非西班牙裔患者和44例非白色患者（包括12例黑人患者和21例西班牙裔患者））被纳入分析队列。在生命的最后6个月，肿瘤诊断、死亡原因或医疗保健利用方面没有显著差异。白色和非白色患者的PPC利用率相似，包括从首次就诊至死亡的时间和PPC就诊的中位次数。与白色患者相比，非白色患者在医院中死亡的可能性显著更高（68% vs 46%，P = 0.03）。一个子队列与记录的偏好（n = 45）分析显示，91%的白色患者和93%的非白色患者死亡在他们的首选位置death.CONCLUSIONSAlthough非白色儿童癌症更有可能死在医院，这种差异是目标一致的，在我们的队列。亚专科PPC访问可能有助于实现目标一致的EOL护理。
BACKGROUNDRacial and ethnic minority children with cancer disproportionately receive intensive care at the end of life (EOL). It is not known whether these differences are goal‐concordant or disparities. The authors sought to explore patterns of pediatric palliative care (PPC) and health care utilization in pediatric oncology patients receiving subspecialty palliative care at the end‐of‐life (last 6 months) and to examine goal‐concordance of location of death in a subset of these patients.METHODSThis was a retrospective cohort study of pediatric oncology patients receiving subspecialty palliative care at a single large tertiary care center who died between January 2013 and March 2017.RESULTSA total of 115 patients including 71 White, non‐Hispanic patients and 44 non‐White patients (including 12 Black patients and 21 Hispanic patients) were included in the analytic cohort. There were no significant differences in oncologic diagnosis, cause of death, or health care utilization in the last 6 months of life. White and non‐White patients had similar PPC utilization including time from initial consult to death and median number of PPC encounters. Non‐White patients were significantly more likely to die in the hospital compared to White patients (68% vs 46%,P= .03). Analysis of a subcohort with documented preferences (n = 45) revealed that 91% of White patients and 93% of non‐White patients died in their preferred location of death.CONCLUSIONSAlthough non‐White children with cancer were more likely to die in the hospital, this difference was goal‐concordant in our cohort. Subspecialty PPC access may contribute to the achievement of goal‐concordant EOL care.