Racial Disparity Found in End-of-Life Discussions

Doctors have trouble communicating with terminally ill black cancer patients about their condition, according to a study released in the Archive of Internal Medicine by Harvard and Dana Farber Cancer Institute-affiliated researchers.

The study followed 71 black patients and 261 white patients, all of whom were in advanced stages of cancer, in treatment centers across the country beginning in 2002. Harvard Medical School professors Holly G. Prigerson and Jennifer W. Mack conducted the study with the help of researchers at other institutions.

In the study, doctors held end-of-life-conversations—during which they reveal to a patient that his or her cancer is terminal, and discuss treatment options—with 35.3 percent of black patients and 38.4 percent of white cancer patients.

The study found that after partaking in those conversations, only 32 percent of black patients indicated that they knew their cancer was terminal, as opposed to 47 percent of white patients. Mack said.

Mack said that if patients understand that their cancer is terminal, they are more likely to chose care to ease their symptoms rather than life-prolonging treatment.

The study found that 19.7 percent of black patients chose to pursue life-prolonging treatment, compared to 6.9 percent of white patients.

Additionally, the findings indicated that black patients did not get the end-of-life treatment they had planned for; black patients who signed “do not resuscitate” orders were just as likely to get life-prolonging treatment as black patients who did not sign such an order.

“Any mismatch can influence the way the communication process goes in the [doctor’s office],” Mack said. She said the miscommunication might be a result of black patients being treated by non-black doctors, cultural differences in the way information is interpreted, and doctors unintentionally communicating differently to black patients.

Prigerson, the principal investigator for the study, said the discrepancy might be related to the religious beliefs of black patients, who tend to be more religious than white patients. She said that end-of-life conversations have little impact on religious patients because they believe their health depends on a higher authority.

K. “Vish” Viswanath, professor at the Harvard School of Public Health and another co-author of the study, said that the cause of the disparity is unclear, but also said he thinks that making information on terminal illness easier to understand and access will help all patients to better understand their condition.

According to Prigerson, the National Cancer Institute has agreed to fund a second study to investigate why end-of-life conversations appear less effective with black patients.

“We have a lot to learn, but [this study] gave us areas to focus on,” Mack said.