Minorities More Likely Than Whites To Seek Aggressive End-of-Life Care, Studies Find
The Washington Post on Monday examined how blacks and other minorities are more likely than whites to "want, and get, more aggressive care as death nears and are less likely to use hospice and palliative care services to ease their suffering." According to a preliminary analysis of an ongoing Harvard University study funded by the National Cancer Institute that will involve 800 terminally ill cancer patients in Massachusetts, Texas, Connecticut, New Hampshire and New York, black participants were two to three times as likely as white participants to seek all possible measures to prolong their lives. The analysis also found that about half of black participants would seek measures to prolong their lives, regardless of whether they had only a few days to live -- about three times the rate among white participants. A second study -- led by Leslie Blackhall, an expert on end-of-life issues at the University of Virginia -- that involved 800 elderly patients in a Los Angeles hospital found black participants were twice as likely as white participants to want their lives prolonged in end-of-life situations, such as an irreversible coma.
According to the Post, part of the explanation for the discrepancy is socioeconomic, as "people with higher income and more access to treatment are about twice as likely to feel comfortable with withdrawing care as those of more modest means." In addition, part of the explanation is that "doctors do not communicate as well with patients from different backgrounds," an issue that in some cases prevents "minorities -- especially the poor and less educated for whom English may be a second language -- from fully understanding how sick they are, what more treatment would achieve, and what hospice or palliative care could do," the Post reports. Religion, which "tends to play a particularly important role for minorities," also "appears to be a key factor," the Post reports. A Harvard study published last month that involved 230 patients found religious participants were more likely to seek measures to prolong their lives in end-of-life situations. Richard Payne, who administers the Institute of Care at the End of Life at Duke University, said, "I think we need to be very attentive to suffering in our patients and do everything we can to help minimize and ameliorate it." He added, "African-Americans and other minorities are at greater risk of not dying well." LaVera Crawley, a Stanford University bioethicist, said, "Not everybody buys into the mainstream image of a 'good death.'" She added, "They don't necessarily want to go peacefully into the night" (Stein, Washington Post, 3/12).