May 5, 2014
Despite advances in cancer treatment and screening, African Americans continue to suffer disproportionately from the majority of cancers; presenting at later stages of disease, having higher mortality rates, and receiving worse end-of-life care. These disparities in end-of-life care have been associated with decreased quality of life and greater physical and emotional distress for African-American patients with advanced cancer. Prior research has identified physician-patient communication as one of the modifiable factors associated with disparities in end-of-life care.
Preliminary results of our pilot work suggest that communication could be improved by having physicians better tailor communication about end-of-life care to the specific information needs and preferences of the patient and family in a culturally-sensitive manner. The goal of this study is to build upon our prior work to better understand racial/ethnic differences in end-of-life communication between physicians and patients with advanced cancer in the hospital, and to develop a patient-centered, culturally-sensitive intervention to help improve communication.
To achieve these study goals, we will: 1) Audiotape inpatient discussions between physicians and African American and Non-Hispanic White patients with advanced cancer to evaluate racial/ethnic differences in both what and how information is being communicated, 2) Interview patients after the discussion to understand their perceptions of the discussion and explore targets for the intervention, and 3) Develop a patient-centered multimedia tool to help facilitate end-of-life communication in a way that respects patient preferences and meets their information needs.
The results of this work will inform a larger study to test a culturally-sensitive intervention to improve inpatient end-of-life communication, and ultimately help patients receive care that is consistent with their preferences and decrease distress levels at the end of life.
Center for Healthcare Studies
Center for Patient Centered Outcomes
Rashmi K Sharma, MD
Kenzie A Cameron, PhD/MPH
Frank J Penedo, PhD
American Cancer Society