Ethnicity and Poverty: Effects on Care at End of Life
Funded by: Brookdale National Fellowship
Project Period: 7/03 - 6/07
Abstract
Objective: The overall goal of the proposed study is to compare
differences in end-of-life care outcomes between Latinos and Caucasians and to evaluate,
through the use of quantitative and qualitative methods, whether these differences are due
to disparities or cultural preferences.
Methods: Adult patients meeting the study eligibility criteria,
admitted to the medicine service of the three study hospitals (Denver Health Medical
Center, Denver Veterans’ Affairs Medical Center, and University Hospital), are invited to
participate in a brief quantitative interview focusing on their ethnicity and other social
factors including socioeconomic status and social support. Subjects are interviewed at the
time of hospital admission, and a chart review is performed. Subjects are followed up in
one year to determine mortality status. Regression modeling will be used to examine how
ethnicity relates to the outcome measures-specific aspects of end of life care including
advance care planning, pain evaluation and management, and control over site of death.
Approximately 900 patients will be needed to detect significant differences between Latinos
and Caucasians. Qualitative interviews will be employed to further explore the relationship
of cultural preferences and the outcome measures. These interviews will be conducted in a
subsample of subjects self-identifying as Latino. Grounded theory will be used to guide
the qualitative analysis.
Current Project Status: Extensive pilot testing has been completed
for recruitment methods, the quantitative interview instrument, and chart review instrument.
In addition, Spanish language translations of the quantitative interview have been completed
and pilot tested. To date, 150 patients have been enrolled and have completed the
quantitative interview and chart review. The qualitative interview is currently being
developed and pilot testing will begin in November of this year.
Key Staff: Fischer, Casiano, Kramer, Kutner, Sauaia
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