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Racial Differences in Predictors of Intensive End-of-Life Care in Advanced Cancer Patients
Journal of Clinical Oncology, 10/08/09

Loggers ET et al. – White patients with advanced cancer are more likely than black patients with advanced cancer to receive the EOL care they initially prefer. EOL discussions and DNR orders are not associated with care for black patients, highlighting a need to improve communication between black patients and their clinicians.

Exclusive Author Commentary
Holly G. Prigerson, 10/09/09

This study of racial disparities in end-of-life care found that white cancer patients who opted for aggressive measures in hopes of prolonging life were three times more likely to receive them than were black patients with the same preference. “None of the white patients who reported the completion of a DNR order at baseline subsequently received intensive care in the last week of life” said Holly Prigerson, PhD, senior author of the study.” “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. ” 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. Tstudy’s findings highlight the need to improve clinical communication between black patients and their oncology providers. Enhanced communication would help to ensure that patients appreciate the risks and benefits of intensive care and that providers are better informed of their patients’ wishes. The findings also identify the need to ensure greater continuity of care, including the transfer of important medical information along with the transfer of care (e.g., through a centralized medical recording system where code status could be universally accessed). More effective communication may be the means to achieving equal and high quality care for black and white patients at life’s end.

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