Researchers did not observe significant racial differences in various aspects of end-of-life care in the United States; however, they reported that both black and white respondents found flaws in the quality of palliative and hospice care, according to data published in JAMA Internal Medicine.
“Prior studies have identified racial disparities in multiple areas of end-of-life care, including symptom management, communication and clinical outcome,” Rashmi K. Sharma, MD, MHS, from the division of general internal medicine at the University of Washington, Seattle, and colleagues wrote. “Recent efforts to improve palliative care and hospice services may help reduce these disparities.”
To determine whether racial differences exist in the quality of end-of-life care in the United States, researchers evaluated survey data from 2011 to 2015 on functioning in late life collected from a national cohort of Medicare enrollees aged 65 years or older.
The investigators asked a proxy respondent, usually a family member, to answer questions regarding the decedent’s end-of-life care on pain and symptom management, decision-making, emotional support and an overall quality rating, and assessed racial differences in respondent perceptions of each quality measure.
Assessment of 1,726 interviews showed that compared with white patients, black patients were more likely to die in the hospital, specifically in the ICU, and fewer black decedents used hospice services in the last month of life. Respondents who answered for white decedents were more likely than those for black decedents to report lack of respect (16.8% vs. 11.3%; P=.02); but there were no significant differences between black and white decedents for the other quality measures. Additionally, there were no significant racial differences in care quality among patients who used hospice in the last month of life.
Overall, less than half of the respondents for both black (47.7%) and white (49.4%) decedents reported that they had received excellent end-of-life care, while approximately one-fifth of respondents for black (20.4%) and white (22.9%) decedents reported that family members weren’t always kept informed.
“Respondents reported many deficiencies in the quality of end-of-life care for both black and white decedents, including unmet symptom needs, problems with communication and suboptimal decision-making,” Sharma and colleagues wrote.
“Overall care quality was rated good, fair or poor (rather than very good or excellent) for approximately one of five included decedents [which] adds to previously reported concerns that the quality of end-of-life care may be worsening for older people in general and suggests that improvements are needed for all patients in the United States,” they concluded. – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.