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.
Borum, Marie L. MD, MPH *; Lynn, Joanne MD, MS, MA +; Zhong, Zhenshao PhD *
Journal of the American Geriatrics Society.
48(5) SUPPLEMENT:S194-S198, May 2000.
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.
(C) 2000 Lippincott Williams & Wilkins, Inc.