Disparities in End-of-Life Care in Children Dying of Cancer in Alabama (RP419)

Disparities in End-of-Life Care in Children Dying of Cancer in Alabama (RP419)

Objectives Inform attendees on rates and trends in pediatric end-of-life care in Alabama. Demonstrate health disparities in end-of-life care in pediatric cancer in Alabama. Background. Nearly 2,800 children die from cancer annually, yet gaps remain in our understanding of their end-of-life (EOL) car...

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Bibliographic Details
Published in:Journal of pain and symptom management 2020-07, Vol.60 (1), p.225-225
Main Authors: Davis, Elizabeth, Martinez, Isaac, Bhatia, Smita, Johnston, Emily
Format: Article
Language:eng
Subjects:
African Americans
Artificial respiration
Cancer
Central nervous system
Children
Clinical outcomes
Consultation
Death & dying
Dialysis
End of life decisions
Health disparities
Hospice care
Inequality
Intensive care
Intensive treatment
Medical diagnosis
Nervous system
Oncology
Palliative care
Pediatrics
Racial inequalities
Sexually transmitted diseases
Sociodemographics
STD
Tumors
Ventilation
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Summary:Objectives Inform attendees on rates and trends in pediatric end-of-life care in Alabama. Demonstrate health disparities in end-of-life care in pediatric cancer in Alabama. Background. Nearly 2,800 children die from cancer annually, yet gaps remain in our understanding of their end-of-life (EOL) care. Racial disparities exist in medical intensity (e.g. mechanical ventilation, hemodialysis) of adult EOL care that do not reflect patient preference. It is unknown if the same racial disparities exist in pediatric oncology EOL, especially among African Americans. Objective. To determine rates of and disparities in EOL care for Alabamian children dying of cancer. Method(s). We conducted a retrospective electronically medical record review of pediatric cancer patients who received their oncology care at Children's of Alabama and died between 2012 and 2018. We collected sociodemographics and clinical and EOL care details. We calculated rates 1) hospital death, 2) receiving medically intense interventions in the last 30d of life, 3) having $2 intensity indicators, 4) palliative care consultation. We constructed multivariable regression models to determine the association between clinical and sociodemographic variables and the above outcomes. Results. Of the 150 patients, the average death age was 11y (STD: 6.8), 40% had a primary diagnosis of non-CNS solid tumor, and 35% were African American. Forty-six percent died in the hospital, 57% received medically intense care, 79 % $2 intensity indicators, and 58% a palliative care consultation. Nonwhite individuals (primarily African American) were more likely to receive medically intense EOL care (AOR: 2.6, 95% CI: 1.1-5.9) than non-Hispanic white patients. Patients with hematologic malignancies had greater odds of receiving medically intense EOL care (3.1, 1.1-8.8) and dying in the hospital (3.7, 1.2-11.0) than patients with central nervous system (CNS) tumors. Conclusion(s). This is the first study to examine patterns of care and disparities of EOL care for children with cancer in the Deep South. It is critical to determine if the racial disparities found are goal concordant or due to systemic issues such as lack of hospice access.
ISSN:0885-3924
1873-6513