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The Effects of Patient Race on Outcomes in Seriously Ill Patients in SUPPORT: An Overview of Economic Impact, Medical Intervention, and End‐Of‐Life Decisions
Author(s) -
Borum Marie L.,
Lynn Joanne,
Zhong Zhenshao
Publication year - 2000
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2000.tb03132.x
Subject(s) - medicine , medicaid , life expectancy , intervention (counseling) , race (biology) , gerontology , health care , family medicine , population , psychiatry , environmental health , botany , economics , biology , economic growth
BACKGROUND: Black Americans have significantly lower life expectancy than white Americans. Racial differences in medical access, management, and DNR orders have been documented. OBJECTIVE: To review the effects of patient race on intervention and end‐of‐life decisions in seriously ill patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). DESIGN: Review of published analyses from SUPPORT. SETTING: Five teaching hospitals PARTICIPANTS: A total of 9105 patients aged 18 years or older (15% black race) meeting diagnostic and illness severity criteria. MEASUREMENT: Analysis of data collected by chart abstraction and interviews. RESULTS: Blacks reported significant loss in savings, although adjusting for diagnosis and disease severity did not demonstrate significant racial differences. Economic hardship was associated with a preference for comfort care, except in black patients (OR 0.71; CI 95%, 0.57‐0.88). Blacks received less intervention with no significant difference in survival. Pain level and control were not affected by race. Blacks were more likely to want CPR, although adjustment for self‐pay or Medicaid eliminated racial differences. Blacks were more likely to continue to prefer CPR 2 months after hospitalization (28% vs 17%) and were more likely to change a DNR order to preferring CPR (40 vs 27%). Blacks also more frequently wished to discuss CPR preferences with their physicians but were less likely to have this type of communication (OR 1.53; CI 95%, 1.11‐2.11). CONCLUSIONS: Patient race may impact on medical intervention and preferences in seriously ill patients. However, in this population, the differences are of modest clinical importance.