Receipt Of Ventilation Research Articles

Racial differences in the impact of financial hardship on the intensity of end-of-life cancer care.

6012 Background: Research suggests that Black cancer patients have higher end-of-life (EOL) medical costs than White patients; and that Black, compared with White, families are more likely to use all or most of their savings to pay for EOL care. Although Black cancer patients receive more intense EOL care than Whites, research has yet to determine the effect of financial hardship on receipt of intensive EOL care, and whether the effect varies by the patient’s race. Methods: Coping with Cancer (CwC) is a longitudinal, multi-site cohort study of advanced cancer patients and their informal caregivers recruited from September 2002-February 2008. CwC was designed to investigate Black/White differences in EOL care. The purpose of this analysis was to determine the association between baseline financial hardship and receipt of intensive EOL care in the last week of life (CwC deceased cohort N=342), and to identify racial differences in this association. Financial hardship was defined as whether the household had to use all or most of their savings due to the family member’s illness (response =yes/no). Intensive EOL care was defined as the receipt of ventilation or resuscitation in the last week of life assessed by medical record review and patient’s caregiver. Results: Patients reporting financial hardship had higher odds of receiving intensive EOL care (OR = 2.83, CI: 1.33, 6.05). After adjusting for socio-demographic characteristics the significant association remained (OR = 2.55, CI: 1.13, 5.81). Race-stratified fully adjusted models revealed no statistically significant association between financial hardship and intensive EOL care for Whites; however, for Blacks, those reporting financial hardship had over five times higher odds of receiving intensive EOL care (OR = 5.21, CI: 1.51, 17.99) compared to those not reporting financial hardship. Conclusions: Financial hardship was associated with greater likelihood of receiving intensive EOL care. The intensity of EOL care received by White patients was insensitive to financial hardship; in contrast Black patients reporting depletion of life savings for cancer care were much more likely to die receiving intensive EOL care than their non-financially strained counterparts.

Religious coping and behavioral disengagement: opposing influences on advance care planning and receipt of intensive care near death

This study examines the relationships between methods of coping with advanced cancer, completion of advance care directives, and receipt of intensive, life-prolonging care near death. The analysis is based on a sample of 345 patients interviewed between January 1, 2003, and August 31, 2007, and followed until death as part of the Coping with Cancer Study, an NCI/NIMH-funded, multi-site, prospective, longitudinal, cohort study of patients with advanced cancer. The Brief COPE was used to assess active coping, use of emotional-support, and behavioral disengagement. The Brief RCOPE was used to assess positive and negative religious coping. The main outcome was intensive, life-prolonging care near death, defined as receipt of ventilation or resuscitation in the last week of life. Positive religious coping was associated with lower rates of having a living will (AOR = 0.39, p = 0.003) and predicted higher rates of intensive, life-prolonging care near death (AOR, 5.43; p<0.001), adjusting for other coping methods and potential socio-demographic and health status confounds. Behavioral disengagement was associated with higher rates of DNR order completion (AOR, 2.78; p = 0.003) and predicted lower rates of intensive life-prolonging care near death (AOR, 0.20; p = 0.036). Not having a living will partially mediate the influence of positive religious coping on receipt of intensive, life-prolonging care near death. Positive religious coping and behavioral disengagement are important determinants of completion of advance care directives and receipt of intensive, life-prolonging care near death.

Coping with cancer: Associations between coping methods and use of intensive life-prolonging care near death

9575 Background: Cancer patients cope with advanced illness in a variety of ways, including relying on their religious beliefs. Religious coping has been associated with preference for aggressive care near death, yet little is known about how religious and other coping mechanisms effect the use of intensive life-prolonging care at the end-of-life (EOL). We sought to determine how patient coping mechanisms affect the use of intensive life-prolonging EOL care among advanced cancer patients. Methods: The Coping with Cancer Study is a US multi-site, prospective, longitudinal cohort of 345 advanced cancer patients enrolled January, 2003 -August, 2007. The Brief COPE assessed active coping (e.g., problem solving), emotional-support based coping (e.g., getting comfort from others), and behavioral disengagement (e.g., giving up the attempt to cope). The Brief RCOPE assessed positive religious coping (e.g., seeking a strength and guidance from God) and negative religious coping (e.g., believing illness is God's punishment). Patients were followed until death, a median of 122 days after baseline assessment. The main outcome was receipt of intensive life-prolonging care, defined as receipt of ventilation or resuscitation in the last week of life. Results: Greater use of positive religious coping prospectively predicted receipt of intensive life-prolonging care (AOR, 5.43; p&lt;0.001), ventilation (AOR, 4.40; p&lt;0.01), resuscitation (AOR, 5.19; p&lt;0.05), and death in the intensive care unit (AOR, 2.76; p&lt;0.05) in the last week of life, controlling for confounding factors and other examined coping styles. In analyses that adjusted for significant confounding influences, behavioral disengagement was associated with DNR order completion (AOR, 2.80; p&lt;0.01), and prospectively predicted lower rates of intensive life-prolonging care (AOR, 0.20; p&lt;0.05), and ventilation (AOR 0.13, p&lt;0.05). Conclusions: The manner in which patients cope with advanced cancer predicts receipt of intensive life-prolonging care at the EOL. Specifically, positive religious coping predicts the receipt of aggressive medical care near death. No significant financial relationships to disclose.