Dying to Live and Living to Die: Addressing Racial Disparities in Palliative Care

• In Event: 2404 - Student Forum Session: Gender, Racial, and Cultural Disparities in Health and Healthcare

Abstract

Ensuring equity in care practices at the end of life is a vital pursuit, as racial disparities in healthcare remain ubiquitous in the medical field. This study focuses on palliative, non-curative EOL therapy to examine potential disparities between African Americans and whites in choice of care received at the end of life (EOL). Potential racial disparities in EOL care preferences are examined by asking: “Do African Americans choose palliative, non-curative therapy at the end of life less frequently than whites? And if so, what latent mechanisms produce these end-of-life care preference disparities?” Exit interviews with a proxy for deceased respondents for waves 2006-2014 of the Health and Retirement Study are used to operationalize choice of care received at the end of life. Of the participants with written EOL instructions and for whom a proxy participated in the exit interview, 2,871 persons answered the requisite EOL question (measuring choice of only palliative care only) for these analyses. A final analytic sample of 1,347 was produced after removing participants with missing observations for all independent variables. Logistic regression models were used to determine if race is an independent predictor of choosing palliative, non-curative care at the end of life. Analyses confirm that clear inequities between African Americans and whites exist in utilization of palliative, non-curative care services at the end of life (OR = 0.308; p < 0.01). These findings augment empirically-based studies on racial disparities in use of advance care planning, hospice, and palliative services (Hopp 2000; Ludke and Smucker 2007; Welch, Teno, and Mor 2005). This study demonstrates that frequent private prayer mediates the association between race and choice of palliative care services. A key finding of this study is that unfair denial of care has a statistically significant association with palliative care services rendered at the end of life.

Author

• Jennifer McDonnell, Emory University