Unintended harm? : race differences in the relationship between advance care planning and psychological distress at the end-of-life

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LUTH, Elizabeth A. | PRIGERSON, Holly G.

CONTEXT: Research 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. OBJECTIVE: To determine the extent to which the relationship between advance care planning and sadness and anxiety at the end-of-life differs by race. METHODS: 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. RESULTS: Among non-Hispanic black/African-Americans who died, end-of-life discussions and having a healthcare 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=.03; healthcare proxy: from 12% to 42% p=.008). In contrast, among non-Hispanic white decedents, end-of-life discussions and naming a healthcare proxy was not associated with caregivers reporting unmanaged needs related to sadness/anxiety. CONCLUSION: Advance care planning may not work the same way for black and white individuals. End-of-life discussions and naming a healthcare 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.

http://dx.doi.org/10.1016/j.jpainsymman.2018.08.001

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»

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