Columbia University School of Nursing, New York, NY, USA.
Columbia University School of Nursing, New York, NY, USA.
J Am Med Dir Assoc. 2021 Feb;22(2):279-290.e1. doi: 10.1016/j.jamda.2020.12.005. Epub 2021 Jan 9.
Health disparities are pervasive in nursing homes (NHs), but disparities in NH end-of-life (EOL) care (ie, hospital transfers, place of death, hospice use, palliative care, advance care planning) have not been comprehensively synthesized. We aim to identify differences in NH EOL care for racial/ethnic minority residents.
A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered in PROSPERO (CRD42020181792).
Older NH residents who were terminally ill or approaching the EOL, including racial/ethnic minority NH residents.
Three electronic databases were searched from 2010 to May 2020. Quality was assessed using the Newcastle-Ottawa Scale.
Eighteen articles were included, most (n = 16) were good quality and most (n = 15) used data through 2010. Studies varied in definitions and grouping of racial/ethnic minority residents. Four outcomes were identified: advance care planning (n = 10), hospice (n = 8), EOL hospitalizations (n = 6), and pain management (n = 1). Differences in EOL care were most apparent among NHs with higher proportions of Black residents. Racial/ethnic minority residents were less likely to complete advance directives. Although hospice use was mixed, Black residents were consistently less likely to use hospice before death. Hispanic and Black residents were more likely to experience an EOL hospitalization compared with non-Hispanic White residents. Racial/ethnic minority residents experienced worse pain and symptom management at the EOL; however, no articles studied specifics of palliative care (eg, spiritual care).
This review identified NH health disparities in advance care planning, EOL hospitalizations, and pain management for racial/ethnic minority residents. Research is needed that uses recent data, reflective of current NH demographic trends. To help reduce EOL disparities, language services and cultural competency training for staff should be available in NHs with higher proportions of racial/ethnic minorities.
养老院（NH）中普遍存在健康差异，但 NH 临终关怀（EOL）护理（即医院转院、死亡地点、临终关怀使用、姑息治疗、预先护理计划）方面的差异尚未得到全面综合。我们旨在确定少数族裔居民在 NH 临终关怀方面的差异。
本系统评价以系统评价和荟萃分析的首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）为指导，并在 PROSPERO（CRD42020181792）中进行了注册。
患有绝症或接近 EOL 的老年 NH 居民，包括少数族裔 NH 居民。
从 2010 年到 2020 年 5 月，三个电子数据库进行了搜索。使用纽卡斯尔-渥太华量表评估质量。
纳入了 18 篇文章，其中大多数（n=16）质量良好，大多数（n=15）使用的数据截止到 2010 年。研究在少数族裔居民的定义和分组方面存在差异。确定了四个结果：预先护理计划（n=10）、临终关怀（n=8）、EOL 住院（n=6）和疼痛管理（n=1）。在 NH 中，黑人居民比例较高的 EOL 护理差异最为明显。少数族裔居民完成预先指示的可能性较小。尽管临终关怀的使用情况不一，但黑人居民在死亡前使用临终关怀的可能性始终较低。与非西班牙裔白人居民相比，西班牙裔和黑人居民更有可能在 EOL 住院。少数族裔居民在 EOL 时经历更严重的疼痛和症状管理；然而，没有文章研究姑息治疗的具体内容（例如，精神关怀）。
本综述确定了 NH 中少数族裔居民在预先护理计划、EOL 住院和疼痛管理方面的健康差异。需要使用反映当前 NH 人口趋势的最新数据进行研究。为了帮助减少 EOL 差异，应在 NH 中为少数族裔居民提供更多的语言服务和文化能力培训。
