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Abstract: PO1219

End-of-Life Care Experiences and Beliefs Among African American Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ahn, Daniel, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
  • Saunders, Milda Renne, UChicago Medicine, Chicago, Illinois, United States
Background

Prior work has shown that African Americans with end-stage renal disease (ESRD) are less likely than their White counterparts to have discussed end-of-life (EOL) care preferences with their providers, and more likely to prefer life-extending treatments. We sought to determine what demographic and institutional factors are associated with African American ESRD patients’ experiences and beliefs on EOL care

Methods

Self-identifying African American adults receiving hemodialysis at three university-affiliated dialysis units completed surveys about their prior EOL care planning and preferences in various EOL situations. We used bivariable and multivariable logistic regression to analyze the association between EOL care views and several covariates including age, gender, education level, income, insurance, and previous experiences with EOL care discussions.

Results

From June to September 2019, 101 patients completed the study. The mean age was 58.7 years, 52% identified as female, and 42% have been on dialysis for >5 years. Almost 69% of patients reported they had never discussed EOL care with any healthcare provider; 95% (64/69) reported their providers never initiated EOL care conversations with them, though 37% desired them. There was no association between having past EOL care discussions and any clinical or demographic covariates. The proportion agreeing that at the EOL if was wrong to “withhold treatments,” 2) “withdraw treatments,” and 3) “to withhold nutrition and fluids” were 78%, 71%, and 63%, respectively. Previous experience with EOL care discussions with either family or healthcare providers was significantly associated with a decreased likelihood to prefer life-extending treatments at EOL (p<0.05).

Conclusion

A majority of African American patients with ESRD reported never having any EOL care discussions. Most of these patients are open to speaking about EOL care with their healthcare providers but are unwilling to initiate discussions. Furthermore, past experience with EOL care discussions with either family or medical team is associated with a decreased preference for aggressive life-extending care. Despite provider and patient discomfort with EOL care discussions, healthcare providers should address EOL care with African American patients with ESRD to identity how medical care at EOL can be more congruent with their values and needs.

Funding

  • Private Foundation Support