BACKGROUND AND OBJECTIVES: Rates of dialysis withdrawal are higher among the elderly and lower among Blacks, yet it is unknown whether preferences for withdrawal and engagement in advance care planning also vary by age and race or ethnicity. DESIGN, SETTING, PARTICIPANTS AND METHODS: We recruited 61 participants from two dialysis clinics to complete questionnaires regarding dialysis withdrawal preferences in five different health states. Engagement in advance care planning (end-of-life discussions), completion of advance directives and 'do not resuscitate' or 'do not intubate' (DNR/DNI) orders were ascertained by a questionnaire and from dialysis unit records. RESULTS: The mean age was 62 +/- 15 years; 38% were Black, 11% were Latino, 34% were White and 16% of participants were Asian. Blacks were less likely to prefer dialysis withdrawal as compared with Whites (odds ratio 0.16, 95% confidence interval 0.03-0.88) and other race/ethnicity groups, and this difference was not explained by age, education, comorbidity and other confounders. In contrast, older age was not associated with preferences for withdrawal. Rates of engagement in end-of-life discussions were higher than for documentation of advance care planning for all age and most race/ethnicity groups. Although younger participants and minorities were generally less likely to document treatment preferences as compared with older patients and Whites, they were not less likely to engage in end-of-life discussions. CONCLUSIONS: Preferences for withdrawal vary by race/ ethnicity, whereas the pattern of engagement in advance care planning varies by age and race/ethnicity. Knowledge of these differences may be useful for improving communication about end-of-life preferences and in implementing effective advance care planning strategies among diverse haemodialysis patients.
BACKGROUND AND OBJECTIVES: Rates of dialysis withdrawal are higher among the elderly and lower among Blacks, yet it is unknown whether preferences for withdrawal and engagement in advance care planning also vary by age and race or ethnicity. DESIGN, SETTING, PARTICIPANTS AND METHODS: We recruited 61 participants from two dialysis clinics to complete questionnaires regarding dialysis withdrawal preferences in five different health states. Engagement in advance care planning (end-of-life discussions), completion of advance directives and 'do not resuscitate' or 'do not intubate' (DNR/DNI) orders were ascertained by a questionnaire and from dialysis unit records. RESULTS: The mean age was 62 +/- 15 years; 38% were Black, 11% were Latino, 34% were White and 16% of participants were Asian. Blacks were less likely to prefer dialysis withdrawal as compared with Whites (odds ratio 0.16, 95% confidence interval 0.03-0.88) and other race/ethnicity groups, and this difference was not explained by age, education, comorbidity and other confounders. In contrast, older age was not associated with preferences for withdrawal. Rates of engagement in end-of-life discussions were higher than for documentation of advance care planning for all age and most race/ethnicity groups. Although younger participants and minorities were generally less likely to document treatment preferences as compared with older patients and Whites, they were not less likely to engage in end-of-life discussions. CONCLUSIONS: Preferences for withdrawal vary by race/ ethnicity, whereas the pattern of engagement in advance care planning varies by age and race/ethnicity. Knowledge of these differences may be useful for improving communication about end-of-life preferences and in implementing effective advance care planning strategies among diverse haemodialysis patients.
Authors: N S Wenger; D E Kanouse; R L Collins; H Liu; M A Schuster; A L Gifford; S A Bozzette; M F Shapiro Journal: JAMA Date: 2001-06-13 Impact factor: 56.272
Authors: Baohui Zhang; Alexi A Wright; Haiden A Huskamp; Matthew E Nilsson; Matthew L Maciejewski; Craig C Earle; Susan D Block; Paul K Maciejewski; Holly G Prigerson Journal: Arch Intern Med Date: 2009-03-09
Authors: Alexi A Wright; Baohui Zhang; Alaka Ray; Jennifer W Mack; Elizabeth Trice; Tracy Balboni; Susan L Mitchell; Vicki A Jackson; Susan D Block; Paul K Maciejewski; Holly G Prigerson Journal: JAMA Date: 2008-10-08 Impact factor: 56.272
Authors: Nwamaka D Eneanya; Julia B Wenger; Katherine Waite; Stanley Crittenden; Derya B Hazar; Angelo Volandes; Jennifer S Temel; Ravi Thadhani; Michael K Paasche-Orlow Journal: Am J Nephrol Date: 2016-06-29 Impact factor: 3.754
Authors: Keren Ladin; Renuka Pandya; Allison Kannam; Rohini Loke; Tira Oskoui; Ronald D Perrone; Klemens B Meyer; Daniel E Weiner; John B Wong Journal: Am J Kidney Dis Date: 2018-02-01 Impact factor: 8.860
Authors: Nwamaka D Eneanya; Susan M Hailpern; Ann M O'Hare; Manjula Kurella Tamura; Ronit Katz; William Kreuter; Maria E Montez-Rath; Paul L Hebert; Yoshio N Hall Journal: Am J Kidney Dis Date: 2016-09-29 Impact factor: 8.860
Authors: Bernadette A Thomas; Rudolph A Rodriguez; Edward J Boyko; Cassianne Robinson-Cohen; Annette L Fitzpatrick; Ann M O'Hare Journal: Clin J Am Soc Nephrol Date: 2013-04-11 Impact factor: 8.237
Authors: Lilia Cervantes; Michel Chonchol; Romana Hasnain-Wynia; John F Steiner; Edward Havranek; Madelyne Hull; John Rice; Jessica Kendrick; Xochilt Alamillo; Claudia Camacho; Stacy Fischer Journal: J Palliat Med Date: 2019-01-31 Impact factor: 2.947