Researchers recently investigated whether there are racial differences found in the quality of end-of-life care in hospitals, hospices, or at home.
Studies conducted in the United States assessing end-of-life care have shown that there may be differences in quality of care between races in the various areas of end-of-life care, including symptom management, communication, and clinical outcomes. In light of these facts, multiple steps have been taken by hospital management teams to improve the quality of care to these patients and avoid racial differences. Researcher RK Sharma along with her team investigated whether new strategies have reduced racial disparity in this area.
They published their results in the 2017 edition of JAMA Internal Medicine. In order to do this assessment, Sharma and her team analysed survey data that was collected from the National Health and Aging Trends Study (NHATS). The researchers followed the patients throughout the care that they were given at the hospital, hospice, or home. The study was conducted from 2011 to 2015 and included 1,106 patients over the age of 65 years. Information on race was documented and used in the study with the consent of the participants. After the questionnaire was completed by the patient, a relative would also be given a questionnaire to assess their opinion on the end of life care given to the patient.
The questionnaire included opinions on the quality of care received in areas such as the health professionals’ management of symptoms and the pain perceived by the patient, the quickness and effectiveness of their decision making, emotional support by all health professionals involved with the patients, and an overall quality rating of the hospital or hospice.
The results showed that the overall quality of care was equal for both white and black patients. Families of white patients were more likely than black patients to report that the patient was not always treated with respect, that the care decisions were not in accordance to the patient’s wishes, or that there was insufficient input from family members in care decisions. Both black and white respondents reported that end-of-life care was adequate but fewer than half reported that it was excellent.
The overall impression of end-of-life care was not excellent, across both race groups, and suggests that significant changes may be needed to improve care for all patients in the United States. The study did, however, find that significant changes brought about by the hospitals in the US seemed to be having a positive impact in reducing the racial differences in quality of end-of-life care. The results of this experiment signify the positivity that changes in management can bring about to decrease racial differences in quality of care.
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD
Reference: Sharma, R. K., Freedman, V. A., Mor, V., Kasper, J. D., Gozalo, P., & Teno, J. M. Association of Racial Differences With End-of-Life Care Quality in the United States. JAMA Internal Medicine.