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Racial, Cultural, and Ethnic Factors Affecting the Quality of End-of-Life Care in California

LaVera Crawley, MD, MPH, and Marjorie Kagawa Singer, PhD, RN, MN

This report shows how Californians' end-of-life care differs by race and ethnicity. It identifies gaps in providing culturally sensitive services and offers recommendations for change.

As the most ethnically diverse state in the nation, California has an opportunity to set a national example for quality end-of-life care for all its residents. Providing quality care requires knowledge of the populations served and their needs and preferences.

This report reviews and analyzes data along with research from focus groups and surveys. The report examines the causes and patterns of death and dying across California's populations and their impact on the delivery of health care.

Mark Smith Discusses Disparities

In March 2007, Dr. Mark D. Smith, president and CEO of the California HealthCare Foundation, presented the findings of this report to the Association of Health Care Journalists. The slides are available under Document Downloads below.

 

Hospice care is generally considered the "gold standard" for end-of-life care in California and across the country. However, the report finds there is wide variation in preferences for care among various racial and ethnic populations. In addition, there are significant limitations on the availability and appropriateness of hospice for some patients:

  • Requirements for hospice enrollment can conflict with the preferences of patients. In particular, African Americans and Latinos may not want to forgo acute therapies not covered by Medicare's hospice benefit, the report concluded. Medicare and most private insurance companies require a life-expectancy prognosis of six months or less for a patient to be eligible for hospice services, and they do not cover care that combines both hospice (pain management and supportive services) and such curative or life-prolonging services as chemotherapy or dialysis.
  • Ethnically diverse populations are significantly less likely to use hospice care than whites. In 2004, for example, of those who died while receiving hospice services, only 4% were Asian American, 6% were African American, and 15% were Latino, contrasted with 74% who were white.
  • Sudden deaths due to accidents and assaults are comparatively higher among young Latinos (16%), African Americans (11%), and Native Americans (14%) than among whites (7%) and Asian Americans (8%). However, the report found that some end-of-life services, such as family support programs and bereavement counseling, are lacking in most emergency departments.

The full report and supplemental materials on methodology are available under Document Downloads.

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