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Do Hispanics prefer to be full code at the end of life? The impact of palliative care consults on clarifying code status preferences and hospice referrals in Spanish-speaking patients

Published online by Cambridge University Press:  14 July 2020

Fernando Kawai Open the ORCID record for Fernando Kawai [Opens in a new window] ,
Cynthia X. Pan ,
John Zaravinos ,
Min Min Maw  and
Gary Lee
Fernando Kawai*
Affiliation:
Department of Medicine, Weill Cornell Medical College Flushing, New York Presbyterian Queens, New York, NY
Cynthia X. Pan
Affiliation:
Department of Medicine, Weill Cornell Medical College Flushing, New York Presbyterian Queens, New York, NY
John Zaravinos
Affiliation:
VITAS Healthcare Corp Hospice, Miami, FL
Min Min Maw
Affiliation:
Geisinger-Lewistown Hospital, Lewistown, PA
Gary Lee
Affiliation:
Suncrest Hospice Freemont, Fremont, CA
*
Author for correspondence: Fernando Kawai, Department of Medicine, New York Presbyterian Queens, 56-45 Main St Flushing, NY 11035, USA. E-mail: fek9007@nyp.org
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Abstract

Background

Hispanics often have disparities at the end of life. They are more likely to die full code and less likely to have discussions regarding prognosis and do not resuscitate (DNR)/do not intubate (DNI), despite studies showing Hispanic values comfort over the extension of life. Barriers to patient-centered care include language,socioeconomic status and health literacy.

Context

We evaluated the impact of palliative care (PC) consults on the change of code status and hospice referrals, comparing seriously ill Hispanic and non-Hispanic white patients.

Method

A retrospective cohort study of all white and Hispanic patients referred to the PC service of a county hospital from 2006 to 2012. We evaluated ethnicity, language, code status at admission and after PC consult, and hospice discharge. Chi-squared tests were used to analyze characteristics among three groups: non-Hispanic white, English-speaking Hispanic, and Spanish-speaking Hispanic patients.

Results

Of 925 patients, 511 (55%) were non-Hispanic white, 208 (23%) were English-speaking Hispanic, and 206 (22%) were Spanish-speaking Hispanic patients. On admission, there was no statistically significant difference in code status among the three groups (57%, 64%, and 59% were full code, respectively, p = 0.5). After PC consults, Spanish-speaking Hispanic patients were more likely to change their code status to DNR/DNI when compared with non-Hispanic white and English-speaking Hispanic patients (44% vs. 32% vs. 28%, p = 0.05). Spanish-speaking Hispanic patients were more likely to be discharged to hospice when compared with English-speaking Hispanics and non-Hispanic whites (33%, 29%, and 23%, respectively, p = 0.04).

Significance of results

Spanish-speaking Hispanic patients were more likely to change from full code to DNR/DNI compared with non-Hispanic white and English-speaking Hispanic patients, despite similar code status preferences on admission. They were also more likely to be discharged to hospice. PC consults may play an important role in helping patients to align their care with their values and may prevent unwanted aggressive interventions at the end of life.

Keywords

Code statusHispanicHospiceLatino
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 2 , April 2021 , pp. 193 - 197
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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