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. 2016 Feb;140(2):295-300.
doi: 10.1016/j.ygyno.2015.12.012. Epub 2015 Dec 17.

Dying well: How equal is end of life care among gynecologic oncology patients?

Jolyn S Taylor  1 , Alaina J Brown  2 , Lauren S Prescott  2 , Charlotte C Sun  2 , Lois M Ramondetta  2 , Diane C Bodurka  3
Affiliations

Dying well: How equal is end of life care among gynecologic oncology patients?

Jolyn S Taylor et al. Gynecol Oncol. 2016 Feb.

Abstract

Objective: To identify disparities in utilization of end of life (EoL) resources by gynecologic oncology (GO) patients.

Methods: This retrospective analysis of the medical records of GO patients treated 1/2007-12/2011 and deceased 1/2012-8/2014 evaluated patient demographics, disease characteristics, and utilization of EoL resources. Chi-square, Fisher's exact test, Mann Whitney and Kruskal-Wallis tests were used for statistical analysis.

Results: Of 189 patients analyzed, 113 (60%) were white, 38 (20%) Hispanic, 31 (16%) black, and seven (4%) Asian. Ninety-five (48%) had ovarian cancer, 51 (26%) uterine, 47 (23%) cervical, seven (3%) vulvar/vaginal. In the last 30days of life (DoL), 18 (10%) had multiple hospital admissions, 10 (5%) admitted to the Intensive Care Unit (ICU), 30 (16%) multiple Emergency Room (ER) visits, 45 (24%) received aggressive medical care and eight (4%) received chemotherapy in the final 14 DoL. Furthermore, 54 (29%) had no Supportive Care referral and 29 (15%) no hospice referral. Only 46 (24%) had a Medical Power of Attorney (PoA) or Living Will (LW) on file. Non-white race was associated with increased odds of dying without hospice (OR 3.07; 95%CI [1.27, 2.46], p=0.013). However, non-white patients who enrolled in hospice did so earlier than white patients (42 v. 27days before death, p=0.054). Non-white patients were also significantly less likely to have PoA/LW documentation (24% v. 76%, p=0.009) even if enrolled in hospice (12% v. 31%, p=0.007).

Conclusions: Significant racial disparities in hospice enrollment and PoA/LW documentation were seen in GO patients. This warrants further study to identify barriers to use of EoL resources.

Keywords: Advance directives; End of life care; Hospice.

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Conflict of interest statement

Conflict of interest statement: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Utilization of End of Life Care (All Patients)
Figure 2
Figure 2
Location of Death by Race
Figure 3
Figure 3
Utilization of End of Life Care by Race
See this image and copyright information in PMC

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