End-of-life treatment preferences: a key to reducing ethnic/racial disparities in advance care planning?
End-of-life treatment preferences: a key to reducing ethnic/racial disparities in advance care planning?
复制标题
临终治疗偏好：在预先护理计划中减少种族/种族差异的关键？
DOI：
10.1002/cncr.28970
复制
发表时间：
2014-12-15
期刊：
影响因子：
6.2
通讯作者：
Prigerson, Holly G.
中科院分区：
文献类型：
--
作者：
Garrido, Melissa M.;Harrington, Shannon T.;Prigerson, Holly G.
关键词：
本研究旨在确定干预措施的目标，以减少晚期癌症患者的临终关怀差异。要做到这一点，我们评估了临终关怀价值观和偏好与种族/少数民族群体中的提前护理计划相关的程度。应对癌症研究从2002年至2008年在五个州的门诊诊所招募了晚期癌症患者。我们检查了606例患者在基线访谈时报告的一种类型的预先护理计划（不复苏[DNR]命令）的比率。双变量检验确定了种族/民族群体内DNR订单完成、宗教价值观和治疗偏好之间的关联。非拉丁裔白色患者（45%）比黑人（25%）和拉丁裔（20%）患者更有可能获得DNR订单（p <0.001）。对特定延长寿命治疗的偏好（例如化疗、通气）是与各组中较高的DNR顺序似然显著相关的唯一因素，非拉丁裔白色患者比拉丁裔或黑人患者更有可能表达对延长生命护理的偏好（例如，26%的非拉丁裔白色患者、46%的黑人患者和41%的拉丁裔患者想要饲管，如果它能延长生命一天，p<0.001）。对延长生命护理的偏好因种族/民族而显着不同，但它们与晚期癌症患者种族/民族群体的DNR订单完成率一致显着相关。针对不同种族/族裔群体与DNR订单相关的偏好的高级护理计划干预措施可能会覆盖广泛的患者人群，并减少临终护理差异。
This study sought to identify targets for interventions to reduce end-of-life care disparities among patients with advanced cancer. To do this, we evaluated the degree to which end-of-life care values and preferences are associated with advance care planning within racial/ethnic minority groups. The Coping with Cancer study recruited patients with advanced cancer from outpatient clinics in five states from 2002-2008. We examined rates of one type of advance care planning, do not resuscitate [DNR] orders, reported at baseline interviews by 606 patients. Bivariate tests determined associations among DNR order completion, religious values, and treatment preferences within racial/ethnic groups. Non-Latino White patients were significantly more likely to have a DNR order (45%) than Black (25%) and Latino (20%) patients (p <.001). Preferences against specific life-prolonging treatments (e.g. chemotherapy, ventilation) were the only factor significantly associated with higher DNR order likelihood in each group, with non-Latino White patients more likely than Latino or Black patients to express preferences against life-prolonging care (e.g. 26% of non-Latino White, 46% of Black, and 41% of Latino patients wanted a feeding tube if it would extend life for one more day, p<.001). Preferences against life-prolonging care differ dramatically by race/ethnicity, but they are uniformly significantly associated with DNR order completion rates across racial/ethnic groups of patients with advanced cancer. Advance care planning interventions that target preferences associated with DNR orders across racial/ethnic groups may reach a broad patient population and reduce end-of-life care disparities.
登录
查看更多内容
影响因子：
120.7
作者：
Phelps, Andrea C.;Maciejewski, Paul K.;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
影响因子：
6.3
作者：
Johnson, Kimberly S.;Kuchibhatla, Maragatha;Tulsky, James A.
通讯作者：
Tulsky, James A.
影响因子：
45.3
作者：
Phipps, E;True, G;Braitman, LE
通讯作者：
Braitman, LE
DOI：
10.1046/j.1532-5415.2002.50073.x
发表时间：
2002-02-01
影响因子：
6.3
作者：
Degenholtz, HB;Arnold, RA;Lave, JR
通讯作者：
Lave, JR
影响因子：
2
作者：
Carr, Deborah
通讯作者：
Carr, Deborah