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Cultural disparities in end-of-life choices and advanced care planning in cancer patients.

Abstract Poster

Authors

null

Vatsala Katiyar

John H. Stroger Jr. Hospital of Cook County, Chicago, IL

Vatsala Katiyar, Ishaan Vohra, Sindhu Janarthanam Malapati, Sunny Singh, Prasanth Lingamaneni, Orlanda Mackie, Ruhi Shariff

Organizations

John H. Stroger Jr. Hospital of Cook County, Chicago, IL, Henry Ford Health System, Detroit, MI, John H. Stroger Hospital of Cook County, John H. Stroger Hospital of Cook County, Chicago, IL

Research Funding

No funding received
None.
Background:

Integration of palliative care early in treatment of malignancy improves quality of life and curbs non-beneficial end of life care. However, there are differences in utilization of palliative services based on cultural background. We aim to identify such differences in a safety net hospital with adiverse patient population.

Methods: This is a single institution retrospective study of adults with cancer who had inpatient palliative care encounter (PCE) between 2012-2017. A representative sample of 130 patients from 7 major ethnicities was included. Statistical analysis was performed using STATA.

Results:

Only 8.4% of all patients had a preceding outpatient PCE. Very few patients had advance directives prior to PCE (range 0-30% for individual ethnicities). As a reflection of their challenging social situation, 5.3% were homeless, 76.1% lived in someone else’s home, <10% had English as primary language (except Caucasian American and African American.) Healthcare utilization in the last 3 months of life varied widely between groups- maximum was in African American and Hispanic patients with ≥3 emergency room visits in 30% and 25% respectively. Table with time to important endpoints and setting of death is attached.

Conclusions:

Palliative service was involved very late in care, with most having significant challenges to complex care discussions including lack of social support and language barrier. Setting of death (ICU versus home) varied by ethnicity, and some groups had high utilization of aggressive end of life care. Understanding the underlying cultural intricacies leading to these choices will help physicians better navigate care and should be a future focus of study.

Ethnicity (n)

Median time (d)

Setting of death

Diagnosis to PCE

PCE to hospice referral

PCE to death

Hospice referral to death

Hospice

Medical floor

ICU

Caucasian European (20)

192

3.5

7.5

43

30%

50%

20%

Caucasian American (20)

162.5

4

4

9

27.5%

50%

12.5%

Hispanic (20)

352.5

0

4

4

12.5%

25%

62.5%

African American (20)

60

26.5

66

13

50%

20%

30%

South East Asian (18)

397

5

8

7

28.6%

42.8%

28.6%

East Asian (20)

184

47.25

110.5

57.5

38.4%

38.4%

23.1%

Middle Eastern (12)

135.5

6.5

18

6.5

66.7%

0%

33.3%

Disclaimer

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Abstract Details

Meeting

2019 Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Advance Care Planning,End-of-Life Care,Communication and Shared Decision Making,Integration and Delivery of Palliative and Supportive Care,Coordination and Continuity of Care,Caregiver Support,Biology of Symptoms and Treatment Toxicities,Disparities in Supportive Care

Sub Track

Advance Care Planning

Citation

J Clin Oncol 37, 2019 (suppl 31; abstr 3)

DOI

10.1200/JCO.2019.37.31_suppl.3

Abstract #

3

Poster Bd #

A12

Abstract Disclosures

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