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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. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
J Am Geriatr Soc. 2000 05; 48(S1):S194-8.JA

Abstract

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.

Authors+Show Affiliations

Department of Medicine, The George Washington University Medical Center, Washington, DC 20037, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

10809475

Citation

Borum, M L., et al. "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. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments." Journal of the American Geriatrics Society, vol. 48, no. S1, 2000, pp. S194-8.
Borum ML, Lynn J, Zhong Z. 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. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc. 2000;48(S1):S194-8.
Borum, M. L., Lynn, J., & Zhong, Z. (2000). 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. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Journal of the American Geriatrics Society, 48(S1), S194-8.
Borum ML, Lynn J, Zhong Z. 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. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc. 2000;48(S1):S194-8. PubMed PMID: 10809475.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. AU - Borum,M L, AU - Lynn,J, AU - Zhong,Z, PY - 2000/5/16/pubmed PY - 2000/6/8/medline PY - 2000/5/16/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - S194 EP - 8 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 48 IS - S1 N2 - 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. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/10809475/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__Study_to_Understand_Prognoses_and_Preferences_for_Outcomes_and_Risks_of_Treatments_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2000&volume=48&issue=S1&spage=S194 DB - PRIME DP - Unbound Medicine ER -