Abstract
BackgroundLatinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults.MethodsSeventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study. Those without ESRD (n = 47) participated in one of five focus group sessions, and those with ESRD on dialysis (n = 26) participated in one-on-one semi-structured interviews. Focus group and individual participants answered questions regarding intensive procedures at the EOL. Recurring themes were identified using standard qualitative content-analysis methods. Participants also completed a brief survey that included demographics, language preference, health insurance coverage, co-morbidities, Emergency Department visits and functional limitations.ResultsThe majority of participants were of Mexican origin with mean age of 70, and there were more female participants in the non-ESRD group, compared to the ESRD dialysis dependent group. The dialysis group reported a higher number of co-morbidities and functional limitations. Nearly 69% of those in the dialysis group reported one or more emergency department visits in the past year, compared to 38% in the non-ESRD group. Primary themes centered on 1) The acceptability of a “natural” versus “invasive” procedure 2) Cultural traditions and family involvement 3) Level of trust in physicians and autonomy in decision-making.ConclusionOur results highlight the need for improved patient- and family-centered approaches to better understand intensive procedure preferences at the EOL in this underserved population of older adults.
Highlights
Latinos in the U.S are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites
People will say that they didn’t try their best to save them.”. This exploratory study found that patients with End Stage Renal Disease (ESRD) on dialysis prefer the continuation of intensive procedures, even when “invasive.” While most of the participants have discussed end of life (EOL) preferences with family members, less than 25% of had written instructions for EOL care or had filed a power of attorney (POA)
Previous similar studies did not focus on those with ESRD but instead explored EOL care preferences among persons with cancer, and like those studies we found that Latinos with ESRD on dialysis are more likely to accept intensive procedures
Summary
Latinos in the U.S are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients on dialysis are at increased risk for hospitalizations, cardiovascular events and premature mortality [1, 2] They may experience significant socioeconomic challenges including high poverty rates, linguistic isolation and low health literacy [3,4,5,6,7]. Latinos are almost twice as likely to progress to End Stage Renal Disease (ESRD), and make up a disproportionate percentage of patients on dialysis, Individuals with advance directives (AD) report better communication about their EOL care preferences and Gonzalez et al BMC Nephrology (2017) 18:319 are less likely to use intensive treatments such as feeding tubes or mechanical ventilation during their last month of life [18]. This study examines intensive procedure preferences at the end of life (EOL) in older Latino adults with and without End Stage Renal Disease (ESRD) on dialysis
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
