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Lack of Ethnic Differences in End-of-Life Care in the Veterans Health Administration

Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Aurora, Colorado, Stacy.Fischer{at}uchsc.edu

Jean S. Kutner, MD

Division of Internal Medicine University of Colorado Health Sciences Center, Aurora, Colorado

Angela Sauaia, MD, PhD

Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Aurora, Colorado

Andrew Kramer, MD

Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Aurora, Colorado

Although existing literature shows pervasive ethnic disparities in end-of-life care, this study sought to determine if there were ethnic differences in the processes of care related to the end of life in a cohort of hospitalized, seriously ill veterans. The medical records of 217 patients (13% African American, 68% white, 9% Hispanic White) were reviewed for documentation of end-of-life care (advance directive discussions, pain, symptom-directed plan, and do-not-resuscitate orders). Logistic regression modeling demonstrated no ethnic differences for the treatment of pain or a symptom-directed plan of care. African American patients were more likely to have a do-not-resuscitate order and advance directive discussion documented compared with white patients. In this equal access system, minority patients were at least as likely or more likely to have important aspects of end-of-life care addressed compared with white patients.

Key Words: ethnicity • end-of-life care • health disparities • advance directives • pain • DNR

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