TY - JOUR
T1 - Greater preferences for death in hospital and mechanical ventilation at the end of life among non-whites recently diagnosed with cancer
AU - Boyce-Fappiano, David
AU - Liao, Kaiping
AU - Miller, Christopher
AU - Peterson, Susan K.
AU - Elting, Linda S.
AU - Guadagnolo, B. Ashleigh
N1 - Funding Information:
This survey study is part (Project 4) of the larger multi-year Comparative Effectiveness Research on Cancer in Texas (CERCIT) program, funded by the Cancer Prevention and Research Institute of Texas (CPRIT) ( https://www.utmb.edu/scoa/research/supported-research-programs/comparative-effectiveness-research-on-cancer-in-texas/current-projects ).[] We recruited potential survey respondents from the state-wide population-based Texas Cancer Registry (TCR) (( https://www.dshs.state.tx.us/tcr/ ).[] A sample of 6222 TCR registrants 18 years of age and older with a diagnosis of a solid tumor malignancy in the past 12 months were obtained. All stages of cancer were included. Of these, 5535 were determined to be alive and able to receive study questionnaires by mail delivery. In total, 1566 individuals responded between March 2018 and July 2020, yielding a response rate of 28.3%. Of these respondents, 1460 (93.2%) were included for this analysis because they provided complete responses to the survey items for the study. We performed telephone follow-up early in the data collection time period in an attempt to increase/solicit further participation, however yield was very low (< 10%). For the first 2300 potential participants, we sent three follow-up reminders and two replacement study questionnaires at 2 weeks, 4–6 weeks, and 8–10 weeks to non-respondents. During the course of this study’s data collection efforts, the TCR/Texas Department of State Health Services changed their policy regarding the number of allowable attempted contacts to potential study participants and we limited contacts accordingly to a single follow-up reminder at 8–10 weeks after first mailing. The subsequent response rates were approximately 25% with either 1 versus 3 mail out attempts. Potential participants’ primary care physicians were notified of the study to ensure that there were no medical objections regarding participation; none objected. Due to resource constraints, questionnaires were available only in English. Individuals identified with Spanish surnames received an additional recruitment letter written in Spanish advising them to have an English-speaking family member to assist with translation of questionnaires.
Funding Information:
This research was supported by a grant from the Cancer Prevention Research Institute of Texas (RP160674, Guadagnolo co-PI). The funding source was uninvolved in the conduct of the research and the interpretation of results.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/11
Y1 - 2021/11
N2 - Purpose: Non-white cancer patients receive more aggressive care at the end-of-life (EOL). This may indicate low quality EOL care if discordant with patient preferences. We investigated preferred potential place of death and preferences regarding use of mechanical ventilation in a cohort of Texas cancer patients. Methods: A population-based convenience sample of recently diagnosed cancer patients from the Texas Cancer Registry was surveyed using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about preferences regarding location of death and mechanical ventilation were the outcome measures of this investigation. Inverse probability weighting analysis was used to construct multivariable logistic regression examining the associations of covariates. Results: Of the 1460 respondents, a majority (82%) preferred to die at home compared to 8% who preferred dying at the hospital. In total, 25% of respondents expressed a preference for undergoing mechanical ventilation at the EOL. Adjusted analysis showed increased preference among Black (OR = 1.81; 95% CI: 1.19–2.73) and other non-white, non-Hispanic race individuals (OR = 3.53; 95% CI: 1.99–6.27) for dying at a hospital. Males, married individuals, those of higher education and poor self-reported health showed significantly higher preference for dying at home. Non-white respondents of all races were more likely to prefer mechanical ventilation at the EOL as were individuals who lived with another person at home. Conclusion: Non-white cancer patients were more likely to express preferences coinciding with aggressive EOL care including dying at the hospital and utilizing mechanical ventilation. These findings were independent of other sociodemographic characteristics, including decisional self-efficacy.
AB - Purpose: Non-white cancer patients receive more aggressive care at the end-of-life (EOL). This may indicate low quality EOL care if discordant with patient preferences. We investigated preferred potential place of death and preferences regarding use of mechanical ventilation in a cohort of Texas cancer patients. Methods: A population-based convenience sample of recently diagnosed cancer patients from the Texas Cancer Registry was surveyed using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about preferences regarding location of death and mechanical ventilation were the outcome measures of this investigation. Inverse probability weighting analysis was used to construct multivariable logistic regression examining the associations of covariates. Results: Of the 1460 respondents, a majority (82%) preferred to die at home compared to 8% who preferred dying at the hospital. In total, 25% of respondents expressed a preference for undergoing mechanical ventilation at the EOL. Adjusted analysis showed increased preference among Black (OR = 1.81; 95% CI: 1.19–2.73) and other non-white, non-Hispanic race individuals (OR = 3.53; 95% CI: 1.99–6.27) for dying at a hospital. Males, married individuals, those of higher education and poor self-reported health showed significantly higher preference for dying at home. Non-white respondents of all races were more likely to prefer mechanical ventilation at the EOL as were individuals who lived with another person at home. Conclusion: Non-white cancer patients were more likely to express preferences coinciding with aggressive EOL care including dying at the hospital and utilizing mechanical ventilation. These findings were independent of other sociodemographic characteristics, including decisional self-efficacy.
KW - Cancer
KW - End of life
KW - Mechanical ventilation
KW - Place of death
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U2 - 10.1007/s00520-021-06226-5
DO - 10.1007/s00520-021-06226-5
M3 - Article
C2 - 33913005
AN - SCOPUS:85105104574
SN - 0941-4355
VL - 29
SP - 6555
EP - 6564
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 11
ER -