In this project, we aim to explain and reduce Latino/non-Latino disparities in advance care planning (ACP) and end-of-life (EOL) care. Latino advanced cancer patients are less likely than non-Latino advanced cancer patients to engage in ACP - a practice to help terminally ill patients and their families achieve EOL goals of care. Consistent with this disparity in ACP, Latino advanced cancer patients receive aggressive, burdensome EOL care more often than do their non-Latino counterparts. They are also less likely than others to use hospice services and to receive EOL care in line with their preferences. Consequently, the EOL care that Latino advanced cancer patients receive appears to be suboptimal, inferior to the care that non-Latino patients receive, infrequently guided by ACP, and often counter to their values. In this project, we will address these disparities in ACP &EOL care through two closely related sub-projects. In the first of these sub-projects, we aim to identify beliefs that contribute to Latino/non-Latino disparities in ACP &EOL care (Specific Aim 1). We will conduct an observational study of beliefs, ACP and EOL outcomes in 400 advanced cancer patients (N=200 Latino;N=200 non-Latino) and their informal caregivers (e.g., spouses;N=400) whom we will recruit from clinics in New York City, Dallas, and Chicago. In this observational study, we will examine the extent to which religious, familial and cultural medical beliefs mediate or moderate Latino/non-Latino disparities in ACP &EOL care, and identify significantly influential beliefs as potential targets of an intervention to reduce those disparitis. In the second sub-project, using results from this observational study as a guide, we aim to develop and pilot a belief-contextualization intervention to reduce Latino/non-Latino disparities in ACP &EOL care (Specific Aim 2).
Specific Aim 2 will proceed in three phases. In Phase I, we will briefly review results of Specific Aim 1 and ask Latino stakeholders to provide input on possible belief-contextualization interventions to determine those likely to be most effective in, and acceptable to, Latino communities. In Phase II, we will design a belief-contextualization intervention to reduce Latino/non-Latino disparities in ACP &EOL care that incorporates elements identified in Phase I and then vet that intervention with a separate group of Latino stakeholders. In Phase III, we will evaluate the feasibility and potential efficacy of the belief-contextualization intervention developed in Phase II. Overall, results of this study will identify influential beliefs that explain Latino/non-Latino disparities in ACP &EOL care, and offer the promise of an effective approach to the reduction of Latino/non-Latino disparities in ACP, and, ultimately, EOL care.
Cancer is the second leading cause of death among Latino and non-Latino (White and Black) Americans. Latinos are the fastest growing ethnic group in the United States, and are less likely than their non-Latino counterparts to engage in advance care planning (ACP). They are also more likely to receive aggressive, burdensome end-of-life (EOL) care at odds with their cultural beliefs. Consequently, there is a pressing need to address Latino/non-Latino disparities in cancer ACP and EOL care. Identification and targeting of influential beliefs about medical care is expected to reduce disparities in ACP and EOL care. It will, thus, reduce disparities in the quality of the medical decision-making and care Latino cancer patients receive near death.
|Garrido, Melissa M; Balboni, Tracy A; Maciejewski, Paul K et al. (2015) Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives. J Pain Symptom Manage 49:828-35|