Sunday, June 5, 2011

Physician Perception of Ethnicity Preferences at End Of Life

I'm not sure what this paper definitely adds to the body of literature, but it's been awhile since I read anything on this topic, so I thought it was interesting.

I will give the disclaimer that this has been my limited anecdotal experience during my time in MICU, SICU, PICU etc., that certain ethnic groups were less likely to be amenable to withdrawal of care discussions, transitions to comfort care, hospice, etc., much to our absolute frustration that we were expending inordinate resources to torture some poor ventilated husk of person with no chance of functional recovery.  This study, in a small single-center sample, more or less confirms that we all share that same perception - but, in theory, it doesn't change our practice.

This study surveyed physicians regarding their perceptions of black vs. white end-stage cancer patients, and they tended to believe that a black person would be more likely to want continued aggressive treatment at the end of life.  The remainder of their article, which is a little more difficult to interpret, basically said that regardless of the perceptions, they still recommended the same (in statistical aggregate) treatment to the black vs. white hypothetical cohorts.

While this study didn't find any measurable treatment differences, we've seen all throughout the literature that perception tends towards reality, and that there are many cases of measurable outcomes differences for different ethnicities.  This study just leaves me with a sour taste and more questions than answers.

http://www.ncbi.nlm.nih.gov/pubmed/21460710

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