Why Do Black Patients Get Unwanted End-of-Life Care?

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Simon Jarratt/Corbis

Many patients with terminal cancer get life-prolonging end-of-life treatment they did not ask for, often due to lack of clear communication with doctors and, disproportionately, those patients are African American.

Ethnic disparities in health and delivery of health care are pronounced in many areas, including traffic accident fatalities, obesity rates and overall mortality. But a recent study in the Archives of Internal Medicine found that African American patients are also more likely to receive end-of-life care they do not want.

Researchers from the Dana-Farber Cancer Institute interviewed 71 black and 261 white patients in Texas and the Northeast United States. All patients had cancer that had spread and that was no longer responding to treatment. Most patients had discussed end-of-life care with their doctors. (More on Time.com: Why Are Black Bikers More Likely to Die in Crashes than Whites?)

Researchers found that black and white patients tended to have end-of-life discussions with their doctors with equal frequency, yet black patients were less likely than whites to understand that their disease was terminal. Black patients also tended to ask for burdensome life-prolonging care more often than whites, and were less likely to have do-not-resuscitate (DNR) orders following discussions with caregivers. What’s more, black patients with DNR orders were just as likely as black patients without DNR orders to receive life-prolonging end-of-life care.

The researchers say that differences in factors such as continuity of care and doctors’ biases regarding what they think patients want may help explain the disparity in care.

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