| EXCEED Project 3 |
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| An Exploration of Racial Differences in End-Of-Life Care
Preferences Among Cancer and CHF Patients in South Carolina |
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We need to better understand the reasons behind the apparent racial
disparities in the use of end-of-life or palliative care options.
The most important overall goal of this proposed study is to better
understand racial differences in preferences for end of life care in
South Carolina, particularly with respect to African Americans, and to
then make this information available to those who will eventually develop
strategies to appropriately address these differences. We will use face-to-face
surveys of both physicians and their patients (with end-stage cancers and
terminal congestive heart failure, as defined using standard guidelines) to
gain a better understanding of communication issues related to end of life
decision making.
The proposed study would attempt to answer three major
research questions, focusing on end of life care preferences held by cancer
and Congestive Heart Failure (CHF) patients in a South Carolina population
with significant numbers of African American, rural and medically underserved
individuals:
- Is there better agreement between physicians and Caucasian patients
than physicians and African American patients regarding whether end of life options
were discussed?
- To what extent are there racial differences in end of life care utilization
preferences between African American and Caucasian cancer and CHF patients, after
controlling for the patients’ clinical condition, income, age, gender, education,
family structure, residence (urban or rural) and insurance status (private, public
or uninsured)?
- If significant racial differences in preferences are found to exist after
controlling for the patients conditions (as set forth in question 1), are the
differences significantly related to differing patient – provider communication
patterns by race, after also controlling for provider variables, such as professional
specialization, years in practice, race, age, gender, institutional affiliation
(community hospital or specialized center) and practice setting (solo or group practice)?
- Do providers believe that their African American patients have different
beliefs and preferences about end of life care than their Caucasian patients, and
do these provider beliefs affect their communication with patients?
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