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Ethnicity, race, and advance directives in an inpatient palliative care consultation service

Published online by Cambridge University Press:  06 July 2012

Glenn B. Zaide ,
Renee Pekmezaris ,
Christian N. Nouryan ,
Tanveer P. Mir ,
Cristina P. Sison ,
Tara Liberman ,
Martin L. Lesser ,
Lynda.B. Cooper  and
Gisele P. Wolf-Klein
Glenn B. Zaide
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Renee Pekmezaris*
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York Feinstein Institute for Medical Research, Manhasset, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
Christian N. Nouryan
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Tanveer P. Mir
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Cristina P. Sison
Affiliation:
Feinstein Institute for Medical Research, Manhasset, New York
Tara Liberman
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Martin L. Lesser
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York Feinstein Institute for Medical Research, Manhasset, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
Lynda.B. Cooper
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York
Gisele P. Wolf-Klein
Affiliation:
North Shore-LIJ Health System, New Hyde Park, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
*
Address correspondence and reprint requests to: Renee Pekmezaris, North Shore-LIJ Health System, 175 Community Dr., Great Neck, NY 11021. E-mail: rpekmeza@nshs.edu
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Abstract

Objective:

Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).

Method:

A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).

Results:

Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.

Significance of results:

This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.

Keywords

PCCEnd of lifeAdvance directiveRaceEthnicityDNRDNI
Type
Original Articles
Information
Palliative & Supportive Care , Volume 11 , Issue 1 , February 2013 , pp. 5 - 11
Copyright
Copyright © Cambridge University Press 2012

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