Type of illness, race can lead to end-of-life care disparity

A patient’s illness, race and ethnicity can significantly influence how much care they receive in their final days or how satisfied their family members may be with that care.

The families of patients with cancer or dementia tend to be more satisfied with the quality of end-of-life care received than the families of patients with organ failure or frailty, according to a study published in the Journal of the American Medical Association Internal Medicine on Sunday.
Patients with cancer or dementia tend to have higher rates of consultations by palliative care specialists and more do-not-resuscitate orders, and fewer tend to die in hospital intensive care units, said Dr. Melissa Wachterman, a physician at Brigham and Women’s Hospital and the VA Boston Healthcare System and lead author of the study. Palliative care is the treatment of pain and other symptoms as well as a service to help ensure that seriously ill patients receive the care they prefer.
“A lot of the focus of end-of-life care is on cancer, but most people don’t die of cancer,” Wachterman said. “Our findings show that the quality of end-of-life care for other illnesses is not as good.”
For the study, which was presented at AcademyHealth’s annual research meeting in Boston on Sunday, the families of more than 34,000 patients who died in the VA health system between 2009 and 2012 were surveyed. The researchers examined the patients’ medical records as well as their family members’ survey responses.
“The main measure that we looked at was, ‘How would you rate the overall care?’ ” Wachterman explained. “There were some other questions about ‘Did you receive care specific to your preferences?’ ‘Did you feel like you were listened to?’ … And our real focus was, ‘How would you describe the care at the end of life?’ “