SESSION TYPE: End of Life Care Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: To compare outcomes of palliative care(PC) interventions in Asians and Caucasians admitted to the ICU.
METHODS: We performed a retrospective chart review in all ICU patients with PC evaluation from 2010-2011. Data collected included age, gender, marital status, race, co-morbidities, days to PCT evaluation, diagnosis, length of stay(LOS) in the ICU, use of vasopressors(vp), mechanical ventilation(MV), hemodialysis(HD), tracheostomy, and PEG. PC data included presence of advance directives(AD) and health care proxy(HCP), reason for consult, and outcomes after family meetings. Chi-square and T-test were performed to compare variables.
RESULTS: A total of 79 patients were evaluated by PC in the ICU. The average age was 75±11 with 24% of the population being Asian and 48% Caucasian. Patients were admitted to the ICU for cardiovascular(28%), oncologic(27%), or respiratory(25%) complications. PC was consulted 4.9±6.6 days after ICU admission, and majority of consultations were to discuss goals of care(89%). In comparison to Caucasians, Asians were more likely to be female(63%vs47%;p=0.0002), married(79%vs44%;p=0.0009), and to have more co-morbidities(≥4 co-morbidities,53%vs32%;p<0.0001). The degree of illness during ICU stay was similar between both groups when measured by the need of MV,vp,HD,PEG tubes, or tracheostomies. There were no intergroup differences in the designation of HCP or AD prior or after PCT consultation. Asians were less likely to seek aggressive care after PCT evaluation; 53% elected for comfort care while only 34% of Caucasians did(p<0.0001). These goals affected ICU treatment; Caucasians were more likely to receive vp, HD, tracheostomies, and PEGs after PCT consult when compared to Asians(p<0.0001).
CONCLUSIONS: In contrary to what is described in the literature of palliative care for minorities, Asians choose less aggressive treatment after PCT consultation when compared to Caucasians. A larger population is necessary to further confirm these findings.
CLINICAL IMPLICATIONS: Ethnicity plays an important role in palliative care(PC). Early involvement of PC, specially in the Asian population, might be beneficial to further guide family members in discussions of goals of care.
DISCLOSURE: The following authors have nothing to disclose: William Hsu, Syed Aslam, Haijun Yao, Cynthia Pan, Cristina Gutierrez
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