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I'll place the text here because in the past I've been told that some can't access the site.
Over the years, U.S. studies have suggested that black patients tend to receive more aggressive medical intervention than white patients near the end of life. In 2016, a groundswell of research confirmed those earlier observations.
In one study, researchers examined national Medicare datasets and found that, among nursing home residents dually eligible for Medicare and Medicaid, 32% of white patients and 43% of black patients were hospitalized during the last 30 days of life (NEJM JW Gen Med Nov 1 2016 and J Am Geriatr Soc 2016; 64:1798). In another study, investigators followed 883 female Medicare recipients who were diagnosed with stage IV breast cancer from diagnosis (between 2007 and 2011) to death. In this cohort, black women were more likely to spend time in an intensive care unit (ICU) or have more than one hospitalization or emergency room visit in their final 30 days of life (40% vs. 29%), were more likely to die in the hospital (36% vs. 22%), and were less likely to use hospice services (60% vs. 71%) compared with white women (NEJM JW Gen Med Aug 1 2016 and J Clin Oncol 2016; 34:2265). In a third study, investigators assessed trends in feeding-tube insertions among nursing home residents with advanced dementia within 12 months after losing the ability to eat independently. Between 2000 and 2014, as an evidence-based consensus developed that this intervention lacked benefit, the percentage of such patients who received feeding tubes fell from 9% to 3% among white patients. Although the percentage also declined among black patients (from 38% to 18%), tube feeding remained much more common in black than in white patients ( and JAMA 2016; 316:769).
Are these apparent racial differences a function of other societal factors? In an analysis of Medicare expenditures for more than 7000 older U.S. adults who died between 1998 and 2012 and who had participated in a biennial longitudinal health survey, researchers adjusted for a broad array of demographic, socioeconomic, geographic, and medical factors. Even then, expenditures in the last 180 days of life remained 22% higher for blacks than for whites ( and J Am Geriatr Soc 2016; 64:1789).
To what extent are these disparities driven by cultural beliefs and preferences? Researchers asked 229 patients with metastatic cancer and clinically-assessed life expectancy of 6 months or shorter how long they expected to live and the source of that expectation. White patients were 5 times more likely than black patients to estimate their survival accurately (within 12 months), and black patients were 6 times more likely than white patients to err in their estimates by at least 5 years. When sources were considered, 21% of white patients and no black patients based their expectations on medical advice; 36% of black patients and 2% of white patients based their expectations on religious beliefs ( and Cancer 2016; 122:1905).
But some authors raised more troubling questions about possible systemic failures. Are white physicians adequately trained to communicate with black patients about end-of-life options? How can clinicians best overcome barriers such as cultural differences and distrust rooted in centuries of discrimination to ensure that patients' end-of-life decisions are fully informed? Little research has addressed these deeper questions.
Why the difference in black vs white medical treatment when death is inevitable? Culture, education, poor communication, trust, religion, .......? And what about financial? Is that taken into consideration differently? Plus, the skeptic part of me wonders if some are more vulnerable and taken advantage of for financial gain.
Thoughts?
Being told you're delusional does not necessarily mean you're mental.
To a very large degree medicine is driven by financial factors. The more they do the more they charge and while medicare does not pay top of the line prices for services no one is losing money by participating. The disparity in hospice service is intriguing.
January 2, 2017 at 12:42 pm (This post was last modified: January 2, 2017 at 12:43 pm by vorlon13.)
If family members for what ever 'cultural' reasons are asking for more or less care, why do I care?
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if there are variations in terminal conditions due to inherent DNA factors that are amenable to 'more aggressive' treatment (I'm thinking kidney failure perhaps, and COPD, maybe some cancers too) well, OK, treatment protocols are different depending on what you got.
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I'm missing something . . .
The granting of a pardon is an imputation of guilt, and the acceptance a confession of it.
Not all babies are born under equal circumstances, and they don't grow up the same way, either.
Poverty is a major factor. Blacks tend to have significantly worse eating habits which leads to all sorts of medical conditions such as diabetes and high blood pressure which in turn leads to kidney disease and cardiovascular issues. It's a little misleading to say that "end-of-life" care differs when you are comparing an 85 year old white with multiple organ failure and a 75 year old black with diabetes or kidney disease.
Not all babies are born under equal circumstances, and they don't grow up the same way, either.
Poverty is a major factor. Blacks tend to have significantly worse eating habits which leads to all sorts of medical conditions such as diabetes and high blood pressure which in turn leads to kidney disease and cardiovascular issues. It's a little misleading to say that "end-of-life" care differs when you are comparing an 85 year old white with multiple organ failure and a 75 year old black with diabetes or kidney disease.
Something along these lines was my first thought as well: I couldn't tell whether age had been controlled for, and it seems natural that younger patients will receive (and ask for) more aggressive care. So, if the average age of a black end-of-life patient is lower than the average age of a white end-of-life patient, that would be a conflating factor that would contribute.
I do think the religious thing is another factor, although probably a small one, and there's all kinds of conflating factors there too. For instance, we know that living in the rural south is correlated with lower income, lower education, and higher rate of belief in certain denominations of Christianity that, for lack of a better way of putting it, believe in a little more 'direct' intervention in human affairs (as opposed to, say, Catholicism). It could be the case that all of these factors conspire to make a rural southerner less likely to accept a diagnosis of brain death or organ failure or need for transplant or anything along those lines. Of course, a higher percentage of rural southerners are black than the average population, so this set of correlations could contribute as well.
All in all I find this very interesting.
How will we know, when the morning comes, we are still human? - 2D
Don't worry, my friend. If this be the end, then so shall it be.
