Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, #520, Baltimore, MD 21205, USA.
Durham VA Health Care System; Department of Medicine, Duke University School of Medicine; National Clinician Scholars Program, Duke Clinical and Translational Science Institute, 701 West Main Street, Durham, NC 27701, USA.
Crit Care Clin. 2024 Oct;40(4):753-766. doi: 10.1016/j.ccc.2024.05.007. Epub 2024 Jun 12.
Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.
在生命末期,来自少数族裔或社会经济地位较低群体的患者接受更密集的治疗,他们更倾向于接受维持生命的治疗,从临床医生那里获得的沟通质量较低,报告的临终质量比其他患者更差。造成这种情况的原因有很多,包括系统(例如,缺乏强化门诊症状管理资源)、临床医生(例如,低质量的严重疾病沟通)和患者(例如,文化规范)等因素。系统和临床医生因素导致了差异,应该予以纠正,而患者因素只是反映了护理方面的差异,可能不是干预的适当目标。