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Instability of Willingness to Accept Life-Sustaining Treatments: Does Race Play a Role? FREE TO VIEW

Jason Chertoff, MD, MPH
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FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida College of Medicine, Gainesville, FL

CORRESPONDENCE TO: Jason Chertoff, MD, MPH, Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32608


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1181-1182. doi:10.1016/j.chest.2016.12.031
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I read with extreme interest the recent article by Houben et al entitled, “Instability of Willingness to Accept Life-Sustaining Treatments of Patients With Advanced Chronic Organ Failure During 1 Year” published in this issue of CHEST (May 2017). The authors’ findings certainly echo the complexity of end-of-life (EOL) preferences but also raise a less obvious but equally important factor that affects EOL preferences—and that is race.

As I reviewed the study’s findings, tables, and figures, I quickly noticed that the racial breakdown of the study participants was not presented. My assumption, since this study was performed in the Netherlands, is that the vast majority of the patients were white. As I am sure you and the investigators are aware, prior research has shown that compared with whites, certain nonwhite minorities are more likely to opt for life-sustaining treatments, even in the context of terminal illness or persistent vegetative state, and less likely to receive comfort-directed care at the end of their lives. Moreover, certain racial minorities are less likely to have do-not-resuscitate orders or advance directives and living wills.,,,

Given the repeatedly proven differences in EOL preferences among whites and certain non-white minorities, I am intrigued to learn about the racial breakdown of the investigators’ study and whether this might have affected their results. Knowing this information is crucial to the generalizability of this study’s results, especially in countries with abundant racial and ethnic diversity like the United States.

Thus, I implore the authors to comment on the racial breakdown of their study, how this breakdown affected their results, and whether their findings are applicable to larger countries with significant racial diversity.

References

Houben C.H.M. .Spruit M.A. .Schols J.M.G.A. .Wouters E.F.M. .Janssen D.J.A. . Instability of willingness to accept life-sustaining treatments in patients with advanced chronic organ failure during 1 year. Chest. 2017;151:1081-1087 [PubMed]journal
 
Hanchate A. .Kronman A.C. .Young-Xu Y. .et al Racial and ethnic differences in end-of-life costs: why do minorities cost more than whites? Arch Intern Med. 2009;169:493-501 [PubMed]journal. [CrossRef] [PubMed]
 
Smith A.K. .Earle C.C. .McCarthy E.P. . Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer. J Am Geriatr Soc. 2009;57:153-158 [PubMed]journal. [CrossRef] [PubMed]
 
Muni S. .Engelberg R.A. .Treece P.D. .et al The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU. Chest. 2011;139:1025-1033 [PubMed]journal. [CrossRef] [PubMed]
 
Hardy D. .Chan W. .Liu C.C. .et al Racial disparities in the use of hospice services according to geographic residence and socioeconomic status in an elderly cohort with nonsmall cell lung cancer. Cancer. 2011;117:1506-1515 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Houben C.H.M. .Spruit M.A. .Schols J.M.G.A. .Wouters E.F.M. .Janssen D.J.A. . Instability of willingness to accept life-sustaining treatments in patients with advanced chronic organ failure during 1 year. Chest. 2017;151:1081-1087 [PubMed]journal
 
Hanchate A. .Kronman A.C. .Young-Xu Y. .et al Racial and ethnic differences in end-of-life costs: why do minorities cost more than whites? Arch Intern Med. 2009;169:493-501 [PubMed]journal. [CrossRef] [PubMed]
 
Smith A.K. .Earle C.C. .McCarthy E.P. . Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer. J Am Geriatr Soc. 2009;57:153-158 [PubMed]journal. [CrossRef] [PubMed]
 
Muni S. .Engelberg R.A. .Treece P.D. .et al The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU. Chest. 2011;139:1025-1033 [PubMed]journal. [CrossRef] [PubMed]
 
Hardy D. .Chan W. .Liu C.C. .et al Racial disparities in the use of hospice services according to geographic residence and socioeconomic status in an elderly cohort with nonsmall cell lung cancer. Cancer. 2011;117:1506-1515 [PubMed]journal. [CrossRef] [PubMed]
 
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