• Fahad Saeed, Susan Ladwig, Rebecca Jane Allen, Nwamaka D Eneanya, TamuraManjula KurellaMKDivision of Nephrology (MKT), Stanford University and Geriatric Research and Education Clinical Center Veterans Affairs Palo Alto, Palo Alto, California, USA., and Kevin A Fiscella.
• Department of Medicine, Division of Nephrology (F.S.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Division of Palliative Care (F.S., S.L.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. Electronic address: fahad_saeed@urmc.rochester.edu.
• J Pain Symptom Manage. 2023 Apr 1; 65 (4): 318325318-325.

ContextAmong people receiving maintenance dialysis, little is known about racial disparities in the occurrence of prognostic discussions, beliefs about future health, and completion of advance care planning (ACP) documents.ObjectivesWe examined whether Black patients receiving maintenance dialysis differ from White patients in prognostic discussions, beliefs about future health, and completion of ACP-related documents.MethodsWe surveyed adult patients receiving maintenance dialysis from seven dialysis units in Cleveland, Ohio, and hospitalized patients at a tertiary care hospital in Cleveland. Of the 450 patients who were asked to participate in the study, 423 (94%) agreed. We restricted the current secondary analyses to include only Black (n=285) and White (n=114) patients. The survey assessed patients' knowledge of their kidney disease, attitudes toward chronic kidney disease (CKD) treatment, preferences for end-of-life (EoL) care, the patient-reported occurrence of prognostic discussions, experiences with kidney therapy decision making, sentiments of dialysis regret, beliefs about health over the next 12 months, and advance care planning. We used stepwise logistic regression to determine if race was associated with the occurrence of prognostic discussions, beliefs about future health, and completion of an ACP-related document, while controlling for potential confounders.ResultsWe found no significant difference in the frequency of prognostic discussions between Black (11.9%) versus White patients (7%) (P=0.15). However, Black patients (19%) had lower odds of believing that their health would worsen over the next 12 months (OR 0.22, CI 0.12, 0.44) and reporting completion of any ACP-related document (OR 0.5, CI 0.32, 0.81) compared to White patients CONCLUSION: Racial differences exist in beliefs about future health and completion of ACP-related documents. Systemic efforts to investigate differences in health beliefs and address racial disparities in the completion of ACP-related documents are needed.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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