Introduction: Cancer end‐of‐life care and associated racial‐ethnic disparities have been in focus during the last few years due to concerns regarding subjective care variations and poor quality of care. Given the high mortality rate and disease burden of lung cancer, end‐of‐life care quality is particularly crucial for this disease. This study uses previously validated measures and examines racial‐ethnic disparities in lung cancer end‐of‐life care quality. Methods: This study involves retrospective analysis of patients ≥66 years, who were diagnosed with stage I–IV lung cancer, and who died on or before December 31, 2013, using the Surveillance Epidemiology and End Result‐Medicare data from 1991–2013. Poor quality of care was measured using three themes: (1) potentially preventable medical encounters, (2) delayed hospice referral, and (3) aggressive chemotherapy provision during end‐of‐life. The patients were analyzed as two separate cohorts of NSCLC and SCLC patients. Logistic regression analyses were performed to estimate racial‐ethnic disparities in the adjusted odds of receiving poor quality end‐of‐life care. Results: The study found considerable racial‐ethnic disparities in end‐of‐life care quality. The racial‐ethnic minorities had higher odds of experiencing potentially preventable medical encounters in the last month of life as compared with non‐Hispanic whites. Odds of delayed hospice referral and aggressive chemotherapy provision during end‐of‐life were lower in non‐Hispanic blacks as compared with non‐Hispanic whites. Conclusions: The study findings highlight the continued lack of access and care disparity among the minorities, which could precipitate potentially preventable utilizations, and limit access to hospice care during end‐of‐life. The study suggests the need to develop educational, patient navigational and other interventions that could potentially reduce aggressive utilizations and improve appropriate hospice care provision during end‐of‐life.

中文翻译：

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肺癌患者临终关怀质量的种族差异：一项基于 SEER 医疗保险的研究

简介：由于对主观护理差异和护理质量差的担忧，癌症临终关怀和相关的种族差异在过去几年中一直受到关注。鉴于肺癌的高死亡率和疾病负担，临终关怀质量对这种疾病尤为重要。本研究使用先前验证过的措施，并检查肺癌临终关怀质量中的种族差异。方法：本研究使用 1991 年至 2013 年的监测流行病学和最终结果医疗保险数据，对≥66 岁、诊断为 I-IV 期肺癌且在 2013 年 12 月 31 日或之前死亡的患者进行回顾性分析。使用三个主题衡量护理质量差：(1) 潜在可预防的医疗遭遇，(2) 延迟的临终关怀转诊，(3) 临终期间提供积极的化疗。将患者分析为两个独立的 NSCLC 和 SCLC 患者队列。进行逻辑回归分析以估计接受低质量临终关怀的调整后的种族差异。结果：该研究发现，在临终关怀质量方面存在相当大的种族差异。与非西班牙裔白人相比，少数民族在生命的最后一个月经历潜在的可预防医疗遭遇的几率更高。与非西班牙裔白人相比，非西班牙裔黑人在临终期间延迟临终关怀转诊和积极化疗的几率较低。结论：研究结果强调了少数民族之间持续缺乏可及性和护理的差异，这可能会导致潜在的可预防利用，并限制在临终期间获得临终关怀。该研究表明，需要制定教育、患者导航和其他干预措施，以潜在地减少积极的使用并改善临终期间适当的临终关怀服务。