1 Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
2 Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York.
J Palliat Med. 2019 Jul;22(7):833-837. doi: 10.1089/jpm.2018.0537. Epub 2019 Apr 11.
Little is known about how immigration status influences preference for life-extending care (LEC) at the end of life (EoL). The purpose was to determine how preference for LEC at the EoL for advanced cancer patients varied by Latino ethnicity and immigrant status, and over time between two large cohorts. Data were derived from two sequential multi-institutional, longitudinal cohort studies of advanced cancer patients, recruited from 2002 to 2008 (coping with cancer I [CwC-1]) and 2010 to 2015 (coping with cancer II [CwC-2]). Self-reported U.S.-born whites (whites) ( = 253), U.S.-born Latinos (US-L) ( = 34), and Latino immigrants (LI) ( = 65) with a poor-prognosis cancer were included. The primary independent variables were immigrant status, Latino ethnicity, and CwC cohort. The primary dependent variable was preference for LEC. Within CwC-2, LI were 9.4 times more likely to prefer LEC over comfort care versus US-L (adjusted odds ratio [AOR] = 9.4; 95% confidence interval [CI]: 1.2-72.4), and US-L were 0.3 times less likely to prefer LEC versus whites (AOR = 0.3; 95% CI: 0.1-1.0). LI from CwC-2 were 11.4 times more likely to prefer LEC versus LI from CwC-1 (AOR = 11.4; 95% CI: 2.7-48.4). Within CwC-1, there was no difference in LEC preference between LI and US-L, nor between US-L and whites. Immigrant status had a strong effect on preference for LEC at the EoL among the more recent cohort of Latino cancer patients. Preference for LEC appears to have increased significantly over time for LI but remained unchanged for US-L. LI may increasingly want LEC near death.
对于移民身份如何影响终末期（EoL）生命延长治疗（LEC）的偏好，人们知之甚少。本研究的目的是确定晚期癌症患者对 LEC 的偏好如何因拉丁裔种族和移民身份而异，并随着两个大型队列之间时间的推移而变化。数据来自于 2002 年至 2008 年（应对癌症 I [CwC-1]）和 2010 年至 2015 年（应对癌症 II [CwC-2]）两个连续的多机构、纵向队列研究中招募的晚期癌症患者。报告了美国出生的白人（白人）（=253）、美国出生的拉丁裔（US-L）（=34）和拉丁裔移民（LI）（=65），他们患有预后不良的癌症。主要的独立变量是移民身份、拉丁裔种族和 CwC 队列。主要的因变量是对 LEC 的偏好。在 CwC-2 中，LI 比 US-L 更有可能选择 LEC 而不是舒适护理（调整后的优势比 [AOR] = 9.4；95%置信区间 [CI]：1.2-72.4），而 US-L 比白人更不可能选择 LEC（AOR = 0.3；95%CI：0.1-1.0）。CwC-2 中的 LI 比 CwC-1 中的 LI 更有可能选择 LEC（AOR = 11.4；95%CI：2.7-48.4）。在 CwC-1 中，LI 和 US-L 之间，以及 US-L 和白人之间，对 LEC 的偏好没有差异。在最近的拉丁裔癌症患者队列中，移民身份对 EoL 时对 LEC 的偏好有很大影响。LI 对 LEC 的偏好似乎随着时间的推移显著增加，但 US-L 保持不变。LI 可能在接近死亡时越来越需要 LEC。
