Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer
Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer
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DOI：
10.1016/j.pec.2019.01.002
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发表时间：
2019-06-01
影响因子：
3.5
通讯作者：
Gramling, Robert
中科院分区：
文献类型：
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作者：
Ingersoll, Luke T.;Alexander, Stewart C.;Gramling, Robert
目的：我们研究了涉及黑人或拉丁裔晚期癌症患者的对话在预后沟通的存在或特征方面是否存在差异。方法：我们对 54 名姑息治疗临床医生和 231 名住院晚期癌症患者之间的初次咨询进行了录音。我们对预后通信的存在和特征进行了编码。我们检查了预后沟通的存在或特征是否因患者自我报告的种族/民族而异。结果：在 231 次咨询中，75.7% 包含预后沟通。与其他人相比，与黑人或拉丁裔患者 (N = 48) 交谈时进行预后沟通的可能性不到一半。在涉及预后的咨询中，涉及黑人或拉丁裔患者的咨询中包含乐观提示预后的可能性比其他患者低 8 倍以上。 结论：黑人和拉丁裔患者的预后沟通频率较低，并且与其他患者的对话相比，包含的乐观提示也较少。需要做更多的工作来更好地理解这些观察到的因种族和民族而异的预后沟通模式。实践意义：越来越多的证据支持预后沟通对于临终决策很重要，并且在非白人群体中极其罕见。因此，我们的研究结果确定了临床干预的潜在显着目标，重点是改善临终关怀方面的差异。 (C) 2019 Elsevier B.V. 保留所有权利。
Objective: We examined whether conversations involving Black or Latino patients with advanced cancer differ in the presence or characteristics of prognosis communication.Methods: We audio-recorded initial consultations between 54 palliative care clinicians and 231 hospitalized people with advanced cancer. We coded for the presence and characteristics of prognosis communication. We examined whether the presence or characteristics of prognosis communication differed by patients' self-reported race/ethnicity.Results: In 231 consultations, 75.7% contained prognosis communication. Prognosis communication was less than half as likely to occur during conversations with Black or Latino patients (N = 48) compared to others. Among consultations in which prognosis was addressed, those involving Black or Latino patients were more than 8 times less likely to contain optimistically cued prognoses compared to others.Conclusion: Prognosis communication occurred less frequently for Black and Latino patients and included fewer optimistic cues than conversations with other patients. More work is needed to better understand these observed patterns of prognosis communication that vary by race and ethnicity.Practice implications: Growing evidence supports prognosis communication being important for end-of-life decision-making and disproportionately rare among non-White populations. Therefore, our findings identify a potentially salient target for clinical interventions that are focused on ameliorating disparities in end-of-life care. (C) 2019 Elsevier B.V. All rights reserved.