More Research into the End-of-Life Care Received by African Americans

In a follow-up study to research released last year, researchers from Dana-Farber Cancer Institute observed that cancer patients’ treatment preferences were less likely to be observed if they were black, rather than white.

"End-of-life care discussions appeared to be more effective in ensuring that white patients' treatment preferences were honored," said Holly Prigerson, PhD, senior author of the report in The Journal of Clinical Oncology. The study is posted on the journal's web site and will be published in a future print edition.

"We are not saying that black treatment preferences were ignored," she emphasized. "Black patients did want, and did receive, more aggressive care than whites. The disparity was in the effect of treatment preferences on care received not that black preferences didn't matter."

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"None of the white patients who reported the completion of a do-not-resuscitate order, or a DNR, order at baseline subsequently received intensive care in the last week of life," said Prigerson. "This did not prove to be the case for black patients. DNR orders did not significantly protect black patients from intensive end-of-life care in this study."

She said the black-white disparity in adherence to advance directives may be linked to gaps in communication, some of which resulted from discontinuities in care that may have been more prevalent in the treatment of black patients.

For example, the researchers identified a few instances where DNR orders completed for black patients fell through the cracks because their informal caregivers (friend or family member) changed over the course of their illness, or because a critically ill patient was treated at a different hospital from the one that normally provided their care.

HFA’s 2009 Initiative is focused on Diversity and End-of-Life Care. As part of that initiative, HFA produced a DVD, African Americans and End-of-Life Care, which examines African-American attitudes about care at the end of life; offers explanations as to why hospice, historically, has not been a choice for many African Americans; looks at grief and the African-American community; and suggests ways to reach out to African Americans who are making end-of-life decisions. The program is available for purchase hereand one Continuing Education credit is available for social workers, nurses, counselors, for an additional small fee.