Abstract
Context
Among people receiving maintenance dialysis, little is known about racial disparities
in the occurrence of prognostic discussions, beliefs about future health, and completion
of advance care planning (ACP) documents.
Objectives
We examined whether Black patients receiving maintenance dialysis differ from White
patients in prognostic discussions, beliefs about future health, and completion of
ACP-related documents.
Methods
We surveyed adult patients receiving maintenance dialysis from seven dialysis units
in Cleveland, Ohio, and hospitalized patients at a tertiary care hospital in Cleveland.
Of the 450 patients who were asked to participate in the study, 423 (94%) agreed.
We restricted the current secondary analyses to include only Black (n=285) and White
(n=114) patients. The survey assessed patients’ knowledge of their kidney disease,
attitudes toward chronic kidney disease (CKD) treatment, preferences for end-of-life
(EoL) care, the patient-reported occurrence of prognostic discussions, experiences
with kidney therapy decision making, sentiments of dialysis regret, beliefs about
health over the next 12 months, and advance care planning. We used stepwise logistic
regression to determine if race was associated with the occurrence of prognostic discussions,
beliefs about future health, and completion of an ACP-related document, while controlling
for potential confounders.
Results
We found no significant difference in the frequency of prognostic discussions between
Black (11.9%) versus White patients (7%) (P=0.15). However, Black patients (19%) had
lower odds of believing that their health would worsen over the next 12 months (OR
0.22, CI 0.12, 0.44) and reporting completion of any ACP-related document (OR 0.5,
CI 0.32, 0.81) compared to White patients
Conclusion
Racial differences exist in beliefs about future health and completion of ACP-related
documents. Systemic efforts to investigate differences in health beliefs and address
racial disparities in the completion of ACP-related documents are needed.
Key Words
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Article info
Publication history
Published online: December 12, 2022
Accepted:
December 2,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Prior abstract publication/presentation: ASN meeting 2019 in form of a poster.
Prior publication: None
Data can be made available upon request.
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
