期刊
JOURNAL OF PALLIATIVE MEDICINE
卷 16, 期 10, 页码 1249-1254出版社
MARY ANN LIEBERT, INC
DOI: 10.1089/jpm.2013.0164
关键词
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资金
- National Institute of Mental Health [MH63892]
- National Cancer Institute [CA 106370]
- Dana-Farber/Harvard Cancer Center [U56CA118641, P30CA0651]
- Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute
- American Society of Clinical Oncology
Background: The role of end-of-life (EOL) care preferences and conversations in receipt of care near death for Latinos is unclear.Objective: This study examines rates and predictors of intensive EOL and hospice care among Latino and white advanced cancer patients. Design: Two-hundred-and-ninety-two self-reported Latino (n=58) and white (n=234) Stage IV cancer patients participated in a U.S. multisite, prospective, cohort study from September 2002 to August 2008. The Latino and white, non-Hispanic participants were interviewed and followed until death, a median of 118.5 days from baseline. Measurements: Patient-reported, baseline predictors of EOL care included EOL care preference; terminal illness acknowledgement; EOL discussion; completion of a DNR order; and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. Hospice was either in- or outpatient. Results: Latino and white patients received intensive EOL and hospice care at similar rates (5.2% and 3.4% for intensive care, p=0.88; 70.7% versus 73.4% for hospice, p=0.33). No white or Latino patient who reported a DNR order or EOL discussion at baseline received intensive EOL care. Religious coping and a preference for life-extending care predicted intensive EOL care for white patients (adjusted odds ratio [aOR] 6.69 [p=0.02] and aOR 6.63 [p=0.01], respectively), but not for Latinos. No predictors were associated with Latino hospice care. Conclusions: EOL discussions and DNR orders may prevent intensive EOL care among Latino cancer patients. Efforts should continue to engage Latino patients and caregivers in these activities.
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