Minorities less likely to plan for end-of-life care

NEW YORK (Reuters Health) - Black and Hispanic adults who are terminally ill are less likely than their white counterparts to have a plan in place for end-of-life care, a new study suggests.

Researchers found that among patients with advanced cancer, African-American and Hispanic patients were about one-third less likely to have an advance care plan -- documented preferences for end-of-life care, such as a living will or do-not-resuscitate order.

In general, minority patients were less likely than whites to consider themselves terminally ill and were more likely to want intensive treatment to prolong their lives. However, that did not explain their lower rates of advanced care planning, the researchers report in the Journal of Clinical Oncology.

For now, the reasons for the racial differences are unclear, according to the investigators, led by Dr. Alexander K. Smith of Beth Israel Deaconess Medical Center in Boston.

Still, past studies may offer some clues, they add.

Some research, for example, has shown that minority patients tend to have less trust in the health system -- which, in theory, could affect their willingness to plan for end-of-life care. It's also possible, according to Smith's team, that the way doctors communicate about terminal illness and advanced care planning plays a role.

There is some evidence, the researchers note, that unconscious racial bias influences some doctors' treatment of patients -- but whether bias affects doctors' communication about end-of-life care is unknown.

Smith and his colleagues based their findings on interviews with 449 cancer patients who were believed to have fewer than six months left to live. They found that 80 percent of white patients had at least discussed end-of-life care with their doctors or had a documented plan in place -- through a living will, for example, or by designating a person to make their medical care decisions if they became too ill to do so.

In contrast, this was true of only 47 percent of both black and Hispanic patients.

Minority patients were more likely than whites to say religion was "very important" to them, and to say they would want life-prolonging treatment, even if they were told they had only a few days to live.

However, those differences did not explain the lower rate of advanced care planning, according to Smith's team. Future studies, they say, should investigate the reasons for the racial disparity.

SOURCE: Journal of Clinical Oncology, September 1, 2008.