• J Pain Symptom Manage · Nov 2018

    Unintended Harm? Race Differences in the Relationship Between Advance Care Planning and Psychological Distress at the End of Life.

    • Elizabeth A Luth and Holly G Prigerson.
    • Weill Cornell Medicine, New York, New York, USA. Electronic address: eal2003@med.cornell.edu.
    • J Pain Symptom Manage. 2018 Nov 1; 56 (5): 752759752-759.

    ContextResearch has revealed racial disparities in advance care planning and intensity of end-of-life care. Studies of the relationship between advance care planning and sadness and anxiety at the end of life are inconclusive.ObjectivesThe objective of this study was to determine the extent to which the relationship between advance care planning and sadness and anxiety at the end of life differs by race.MethodsThis study analyzes data from 315 Medicare beneficiaries from the 2011-2016 National Health and Aging Trends Study. Caregiver-assessed sadness/anxiety at decedent's end of life was categorized as none, managed needs, and unmanaged needs. We used multinomial logistic regression and calculated relative risk and predicted probability of reporting sadness/anxiety by race and advance care planning status, controlling for demographic and health characteristics.ResultsAmong non-Hispanic black/African-Americans who died, end-of-life discussions and having a health care proxy increased the predicted probability of caregivers reporting unmanaged needs related to sadness/anxiety by factors of 2.6 and 3.5, respectively (discussions: from 15% to 39%, P = 0.03; health care proxy: from 12% to 42%, P = 0.008). By contrast, among non-Hispanic white decedents, end-of-life discussions and naming a health care proxy were not associated with caregivers reporting unmanaged needs related to sadness/anxiety.ConclusionAdvance care planning may not work the same way for black and white individuals. End-of-life discussions and naming a health care proxy are potentially harmful to dying black patients' mental health. This finding suggests a need for additional research to understand why caregivers report unmanaged sadness/anxiety for dying black patients who engaged in advance care planning and increased attention to these patients' mental health at the end of life.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…