Racial differences in hospice revocation to pursue aggressive care
Racial differences in hospice revocation to pursue aggressive care
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DOI：
10.1001/archinternmed.2007.36
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发表时间：
2008-01-28
影响因子：
--
通讯作者：
Tulsky, James A.
中科院分区：
文献类型：
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作者：
Johnson, Kimberly S.;Kuchibhatla, Maragatha;Tulsky, James A.
背景：安宁疗护为临终病人提供支持性疗护。然而，一些参保人在临终前离开临终关怀，寻求可能延长生存期的治疗方法。由于非裔美国患者在生命末期更倾向于维持生命的治疗，他们可能比白人患者更有可能退出安宁疗护而寻求延长生命的治疗。方法：对1999年1月1日至2003年12月31日期间从VITAS安宁疗护计划出院的非裔美国人和白人患者进行二次数据分析，我们使用逻辑回归来检验种族与出院处置之间的关系，出院处置定义为撤销安宁疗护以追求积极疗护（例如紧急医疗护理、化疗或侵入性医疗干预）与所有其他出院处置之间的关系。我们使用Cox比例风险模型来检查来自佛罗里达州临终关怀计划的一个亚组患者在终止临终关怀后1年的生存率。结果：在166197名参保者中，2.8%的人取消临终关怀而追求积极治疗，非裔美国患者比白人患者更有可能这样做(4.5% vs 2.5%； P
Background: Hospice provides supportive care to terminally ill patients at the end of life. However, some enrollees leave hospice before death in search of therapies that may prolong survival. Because of a greater preference for life-sustaining therapies at the end of life, African American patients may be more likely than white patients to withdraw from hospice to seek life-prolonging therapies.Methods: In a secondary data analysis of African American and white patients discharged from VITAS hospice programs between January 1, 1999, and December 3 1, 2003, we used logistic regression to examine the association between race and discharge disposition defined as hospice revocation to pursue aggressive care (eg, emergency medical care, chemotherapy, or invasive medical intervention) vs all other discharges. We used a Cox proportional hazards model to examine survival at I year after hospice revocation in a subgroup of enrollees from Florida hospice programs.Results: Of the 166 197 enrollees, 2.8% revoked hospice to pursue aggressive care, and African American patients were more likely than white patients to do so (4.5% vs 2.5%; P