Comparison of advanced care discussions between Chinese-American and Caucasian stage IV cancer patients at a single American cancer center.

Abstract

e19081 Background: Timely discussions with cancer patients on prognosis, goals of care (GOC), and end-of-life care (EOLC) are essential components of quality care for diverse populations. Although Chinese-Americans represent one of the fastest growing ethnic groups in the United States, little is known about the utilization of these advanced care discussions with Chinese-American cancer patients. Methods: In this exploratory review, we collected data for 63 Chinese-American and 63 Caucasian stage IV solid cancer patients at a tertiary medical center who died 2013-2018. The following data points were compared: frequency and timing of prognosis, GOC, and EOLC discussions; family inclusion in discussions; healthcare proxy identification; DNR completion. Results: Chinese-American and Caucasian patients had similar frequencies of prognostic (76% vs 71%), GOC (51% vs 56%), and EOLC discussions (89% vs 84%). For all three types of conversations, Chinese-American patients had the discussions earlier on average (days before death: prognosis 86 vs 62; GOC 54 vs 37; EOLC 69 vs 48) and included family members in the discussions more often (30% vs 15%). Chinese-Americans identified healthcare proxies earlier (50 vs 45 days before death). Chinese-Americans had DNR orders placed later (29 vs 33 days before death) and were more likely to have DNR orders placed on the day of death (30% vs 23%). Conclusions: Despite similar frequency of advanced care discussions, earlier conversations, and earlier identification of healthcare proxies in the Chinese-American group, DNR orders were placed later and were often delayed until the day of death for Chinese-American patients. Further studies are needed to better explore the differences indicated in this preliminary study.