LoPresti Melissa A, Dement Fritz, Gold Heather T
Department of Population Health, New York University School of Medicine, New York, NY, USA.
Department of Medical Library, New York University School of Medicine, New York, NY, USA.
Am J Hosp Palliat Care. 2016 Apr;33(3):291-305. doi: 10.1177/1049909114565658. Epub 2014 Dec 29.
Ethnic/racial minorities encounter disparities in healthcare, which may carry into end-of-life (EOL) care. Advanced cancer, highly prevalent and morbid, presents with worsening symptoms, heightening the need for supportive and EOL care.
To conduct a systematic review examining ethnic/racial disparities in EOL care for cancer patients.
We searched four electronic databases for all original research examining EOL care use, preferences, and beliefs for cancer patients from ethnic/racial minority groups.
Twenty-five studies were included: 20 quantitative and five qualitative. All had a full-text English language article and focused on the ethnic/racial minority groups of African Americans, Hispanics Americans, or Asian Americans. Key themes included EOL decision making processes, family involvement, provider communication, religion and spirituality, and patient preferences. Hospice was the most studied EOL care, and was most used among Whites, followed by use among Hispanics, and least used by African and Asian Americans. African Americans perceived a greater need for hospice, yet more frequently had inadequate knowledge. African Americans preferred aggressive treatment, yet EOL care provided was often inconsistent with preferences. Hispanics and African Americans less often documented advance care plans, citing religious coping and spirituality as factors.
EOL care differences among ethnic/racial minority cancer patients were found in the processes, preferences, and beliefs regarding their care. Further steps are needed to explore the exact causes of differences, yet possible explanations include religious or cultural differences, caregiver respect for patient autonomy, access barriers, and knowledge of EOL care options.
少数族裔在医疗保健方面存在差异，这种差异可能延续到临终关怀（EOL）。晚期癌症发病率高且病情严重，症状不断恶化，因此对支持性和临终关怀的需求日益增加。
进行一项系统综述，研究癌症患者临终关怀中的种族差异。
我们在四个电子数据库中搜索了所有关于少数族裔癌症患者临终关怀使用情况、偏好和信念的原创研究。
纳入了25项研究：20项定量研究和5项定性研究。所有研究均有英文全文，且聚焦于非裔美国人、西班牙裔美国人或亚裔美国人等少数族裔群体。关键主题包括临终决策过程、家庭参与、医护人员沟通、宗教与精神信仰以及患者偏好。临终关怀是研究最多的临终关怀类型，白人使用最多，其次是西班牙裔，非裔美国人和亚裔美国人使用最少。非裔美国人认为对临终关怀的需求更大，但知识往往不足。非裔美国人倾向于积极治疗，但所提供的临终关怀往往与他们的偏好不一致。西班牙裔和非裔美国人较少记录预先护理计划，他们将宗教应对和精神信仰视为影响因素。
少数族裔癌症患者在临终关怀的过程、偏好和信念方面存在差异。需要进一步探讨差异的确切原因，可能的解释包括宗教或文化差异、护理人员对患者自主权的尊重、获取障碍以及对临终关怀选择的了解。
