The effects of patient race on outcomes in seriously ill patients in SUPPORT: An overview of economic impact, medical intervention, and end-of-life decisions

BACKGROUND: Black Americans have significantly lower life expectancy than white Americans. Racial differences in medical access, management, and DNR orders have been documented. OBJECTIVE: To review the effects of patient race on intervention and end-of-life decisions in seriously ill patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). DESIGN: Review of published analyses from SUPPORT. SETTING: Five teaching hospitals PARTICIPANTS: A total of 9105 patients aged 18 years or older (15% black race) meeting diagnostic and illness severity criteria. MEASUREMENT: Analysis of data collected by chart abstraction and interviews. RESULTS: Blacks reported significant loss in savings, although adjusting for diagnosis and disease severity did not demonstrate significant racial differences. Economic hardship was associated with a preference for comfort care, except in black patients (OR 0.71; CI 95%, 0.57-0.88). Blacks received less intervention with no significant difference in survival. Pain level and control were not affected by race. Blacks were more likely to want CPR, although adjustment for self-pay or Medicaid eliminated racial differences. Blacks were more likely to continue to prefer CPR 2 months after hospitalization (28% vs 17%) and were more likely to change a DNR order to preferring CPR (40 vs 27%). Blacks also more frequently wished to discuss CPR preferences with their physicians but were less likely to have this type of communication (OR 1.53; CI 95%, 1.11-2.11). CONCLUSIONS: Patient race may impact on medical intervention and preferences in seriously ill patients. However, in this population, the differences are of modest clinical importance.