Megan Johnson Shen1,2, Holly G Prigerson1,2, Ana I Tergas3,4,5,6, Paul K Maciejewski1,7. 1. 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York. 2. 2 Department of Medicine, Weill Cornell Medicine , New York, New York. 3. 3 Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons , New York, New York. 4. 4 Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons , New York, New York. 5. 5 New York Presbyterian Hospital-Columbia University Irving Medical Center , New York, New York. 6. 6 Department of Epidemiology, Mailman School of Public Health, Columbia University , New York, New York. 7. 7 Department of Radiology, Weill Cornell Medicine , New York, New York.
Abstract
BACKGROUND: Little is known about disparities in end-of-life (EoL) care between U.S. immigrants and nonimmigrants. OBJECTIVE: To determine immigrant/nonimmigrant advanced cancer patient differences in receipt of values-inconsistent aggressive medical care near the EoL. DESIGN: Analysis of data from Coping with Cancer, a federally funded, prospective, multi-institutional cohort study of advanced cancer patients with limited life expectancies recruited from 2002 to 2008. SETTING/ SUBJECTS: U.S. academic medical center and community-based clinics. Self-reported immigrant (n = 41) and nonimmigrant (n = 261) advanced cancer patients with poor prognoses who died within the study observation period. MEASUREMENTS: The primary independent/predictor variable was patient immigrant status. Primary outcome variables: (1) aggressive medical care near death, operationalized as the use of mechanical ventilation, resuscitation, feeding tube, and/or antibiotics in the last week of life and (2) receipt of values inconsistent aggressive care, operationalized as receiving aggressive care inconsistent with stated preferences for comfort-focused EoL care. RESULTS: In a propensity-weighted sample (N = 302), in which immigrant and nonimmigrant groups were weighted to be demographically similar, immigrants were significantly more likely than nonimmigrants to receive aggressive medical care [OR 1.9; 95% CI (1.0-3.6); p = 0.042] and values-inconsistent aggressive medical care [OR 2.1; 95% CI (1.1-4.2); p = 0.032] near death. CONCLUSIONS: Immigrant, as compared with nonimmigrant, advanced cancer patients are not only more likely to receive aggressive EoL care, but also more likely to receive care counter to their wishes. These findings indicate potential disparities in, rather than differences in preference for, aggressive care and a need for further investigation into potential causes of these disparities.
BACKGROUND: Little is known about disparities in end-of-life (EoL) care between U.S. immigrants and nonimmigrants. OBJECTIVE: To determine immigrant/nonimmigrant advanced cancerpatient differences in receipt of values-inconsistent aggressive medical care near the EoL. DESIGN: Analysis of data from Coping with Cancer, a federally funded, prospective, multi-institutional cohort study of advanced cancerpatients with limited life expectancies recruited from 2002 to 2008. SETTING/ SUBJECTS: U.S. academic medical center and community-based clinics. Self-reported immigrant (n = 41) and nonimmigrant (n = 261) advanced cancerpatients with poor prognoses who died within the study observation period. MEASUREMENTS: The primary independent/predictor variable was patient immigrant status. Primary outcome variables: (1) aggressive medical care near death, operationalized as the use of mechanical ventilation, resuscitation, feeding tube, and/or antibiotics in the last week of life and (2) receipt of values inconsistent aggressive care, operationalized as receiving aggressive care inconsistent with stated preferences for comfort-focused EoL care. RESULTS: In a propensity-weighted sample (N = 302), in which immigrant and nonimmigrant groups were weighted to be demographically similar, immigrants were significantly more likely than nonimmigrants to receive aggressive medical care [OR 1.9; 95% CI (1.0-3.6); p = 0.042] and values-inconsistent aggressive medical care [OR 2.1; 95% CI (1.1-4.2); p = 0.032] near death. CONCLUSIONS: Immigrant, as compared with nonimmigrant, advanced cancerpatients are not only more likely to receive aggressive EoL care, but also more likely to receive care counter to their wishes. These findings indicate potential disparities in, rather than differences in preference for, aggressive care and a need for further investigation into potential causes of these disparities.
Entities:
Keywords:
end-of-life care; immigrant; values-inconsistent end-of-life care
Authors: Ursula K Braun; Laurence B McCullough; Rebecca J Beyth; Nelda P Wray; Mark E Kunik; Robert O Morgan Journal: J Natl Med Assoc Date: 2008-09 Impact factor: 1.798
Authors: Elizabeth T Loggers; Paul K Maciejewski; Rachel Jimenez; Matthew Nilsson; Elizabeth Paulk; Heather Stieglitz; Holly G Prigerson Journal: J Palliat Med Date: 2013-09-20 Impact factor: 2.947
Authors: Ana I Tergas; Holly G Prigerson; Megan J Shen; Andreea I Dinicu; Alfred I Neugut; Jason D Wright; Dawn L Hershman; Paul K Maciejewski Journal: Cancer Date: 2022-07-08 Impact factor: 6.921