How the Other Half Dies: Health Disparities and Patient Perceptions of Clinician Bias in End-of-Life Care Recommendations

Abstract: Black Americans are significantly less likely than white Americans to receive hospice care, and significantly more likely than white Americans to receive intensive medical treatments in the last six months of life. Proposed explanations for this difference include religion, culture, and disparate access to hospice and palliative care. We hypothesize that the untrustworthiness of the American healthcare system is another factor that contributes to racial disparities in end-of-life care: some patients reasonably worry that when a system that has too often subjected patients to inferior care or outright harm on account of their race recommends treatment limitations, this reflects yet another effort to shortchange patients of color. To test this, we surveyed patients in two oncology treatment centers within the same healthcare system – one that serves a predominantly white patient population and one whose patients are majority black – about end-of-life care options, perceptions about which options are more likely to be recommended to and adopted by patients depending on their race, wealth, and insurance status, and patient concerns about bias in medical recommendations. This presentation of our findings will highlight what appears to be a potential contributing cause of disparities in end-of-life medical care and suggests that reducing these disparities may require further efforts to repair trust – including, potentially, by surfacing and directly addressing patients’ justifiable concerns about bias in end-of-life goals of care conversations.

Nina Laing, MD – Clinical Social Worker, Palliative Care, MedStar Washington Hospital Center; benjamin krohmal, JD, HEC-C – Director, John J. Lynch, MD Center for Ethics, MedStar Washington Hospital Center; Michael Pottash, MD – Attending Physician, Palliative Care, MedStar Washington Hospital Center