Abstract: SA-PO1049
Racial Disparities in Advance Care Planning in Patients Receiving Maintenance Dialysis
Session Information
- Hemodialysis and Frequent Dialysis - VI
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Saeed, Fahad, University of Rochester Medical Center, Rochester, New York, United States
- Ladwig, Susan K., University of Rochester, Rochester, New York, United States
- Epstein, Ronald M., University of Rochester, Rochester, New York, United States
- Fiscella, Kevin, URMC, Rochester, New York, United States
Background
There is a paucity of literature on racial differences in completion of advance care planning (ACP) documents among maintenance dialysis patients. We studied differences in the presence of advance care planning (ACP) documents in patients receiving maintenance dialysis.
Methods
A forty-one item questionnaire was administered to adult patients receiving maintenance dialysis in seven dialysis units located in the city of Cleveland, Ohio, and its suburbs. Of the 450 patients who were asked to participate in the study, 423 (94%) agreed. Of those who responded, 285 were African Americans, and 114 were Caucasians The questionnaire Items assessed patients’ knowledge of their kidney disease, attitudes toward chronic kidney disease (CKD) treatment, and preference for end-of-life (EoL) care. A single question was used to assess completion of advance care planning documents “Have you completed any of the following?: (a) Living will (b) Personal directive/Medical Order for Life-Sustaining Treatment (MOLST) form (c) Healthcare proxy document (d) Enduring power of attorney (e) None of the above/Don’t know.” All responses about power of attorney were excluded from the current analyses. We used logistic regression to identify predictors of completion of any ACP document. Candidate predictors were patient demographics, attitudes toward CKD treatment, and EoL care preferences.
Results
African American race (OR 0.56, CI 0.35, 0.92, p=0.02) and lack of prognostic discussions (OR 0.48, CI 0.27, 0.87, p=0.02) were associated with a lower odds of having any advance care planning document. Age >65 years (OR 2.1, CI 1.35, 3.26, p=0.001) and religiosity (OR 3.76, CI 1.52, 9.27, p=0.003) were associated with higher odds of completion of ACP documents.
Conclusion
Racial disparities exist in completion of ACP documents. Factors associated with lower odds of advance care planning include African American race and the absence of prognostic discussions. Future interventions are needed to mitigate racial disparities in completion of ACP and encourage prognostic discussion with dialysis patients.