Racial disparities in the frequency and timing of code status orders among women with breast cancer
Abstract Background Black/African American women with breast cancer have a disproportionately higher risk of mortality compared to other race groups, although their overall incidence of disease is lower. Despite this, advance care planning (ACP) and consequent code status documentation remain low in...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-11-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-024-13132-6 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846158446408237056 |
|---|---|
| author | Plamena P. Powla Heidy Medina Dario Villamar Clarissa Huard Julia Meguro Mariana Khawand-Azoulai Patricia I. Moreno Marcia M. Tan |
| author_facet | Plamena P. Powla Heidy Medina Dario Villamar Clarissa Huard Julia Meguro Mariana Khawand-Azoulai Patricia I. Moreno Marcia M. Tan |
| author_sort | Plamena P. Powla |
| collection | DOAJ |
| description | Abstract Background Black/African American women with breast cancer have a disproportionately higher risk of mortality compared to other race groups, although their overall incidence of disease is lower. Despite this, advance care planning (ACP) and consequent code status documentation remain low in this vulnerable patient population. Code status orders (i.e., Full code, Do Not Attempt Resuscitation [DNAR], Do Not Intubate [DNI]) allow consideration of patient preferences regarding the use of aggressive treatments, such as cardiopulmonary resuscitation and intubation. The aim of this study is to characterize presence of code status orders and determine whether race affects code status documentation after the first encounter for breast cancer. Methods Data were derived from 7524 women with breast cancer from the University of Chicago Medical Center (UCMC) between 2016 and 2021. Cox regression was used to estimate the effects of race and adjusted for age, ethnicity, inpatient stays, metastatic breast cancer, marital status, and body mass index. Results The sample included 60.5% White, 3.6% Asian/Mideast Indian, 28.9% Black/African American, and 7.0% other or unknown race. Results indicate that code status orders after the first breast cancer encounter were uncommon (7.2%). Black/African American race (HR = 2.74; 95% CI: 1.75, 4.28) emerged as a significant factor associated with any code status orders compared to other race groups even when adjusting for covariates. Conclusions Code status documentation in this sample of women with breast cancer was low overall, yet rates were higher among Black/African American patients compared to other race groups. In fact, race remains a significant predictor of code status documentation even when accounting for indirect measures of cancer severity. This could be denoting the racial disparities (e.g., higher cancer malignancy such as triple negative breast cancer) in breast cancer mortality risk. Future research is needed to identify factors unique to Black/African American women that would increase code status documentation so that goal concordant care can be prioritized among patients with breast cancer. |
| format | Article |
| id | doaj-art-4ac9b815730a43b48e77a6782163130d |
| institution | Kabale University |
| issn | 1471-2407 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj-art-4ac9b815730a43b48e77a6782163130d2024-11-24T12:30:14ZengBMCBMC Cancer1471-24072024-11-012411910.1186/s12885-024-13132-6Racial disparities in the frequency and timing of code status orders among women with breast cancerPlamena P. Powla0Heidy Medina1Dario Villamar2Clarissa Huard3Julia Meguro4Mariana Khawand-Azoulai5Patricia I. Moreno6Marcia M. Tan7Department of Public Health Sciences, University of Chicago Medical CenterDepartment of Public Health Sciences, University of Miami Miller School of MedicineDepartment of Public Health Sciences, University of Chicago Medical CenterDepartment of Public Health Sciences, University of Chicago Medical CenterDepartment of Medicine, University Miami Miller School of MedicineDepartment of Medicine, Division of Geriatrics and Palliative Medicine, University Miami Miller School of MedicineDepartment of Public Health Sciences, University of Miami Miller School of MedicineDepartment of Public Health Sciences, University of Chicago Medical CenterAbstract Background Black/African American women with breast cancer have a disproportionately higher risk of mortality compared to other race groups, although their overall incidence of disease is lower. Despite this, advance care planning (ACP) and consequent code status documentation remain low in this vulnerable patient population. Code status orders (i.e., Full code, Do Not Attempt Resuscitation [DNAR], Do Not Intubate [DNI]) allow consideration of patient preferences regarding the use of aggressive treatments, such as cardiopulmonary resuscitation and intubation. The aim of this study is to characterize presence of code status orders and determine whether race affects code status documentation after the first encounter for breast cancer. Methods Data were derived from 7524 women with breast cancer from the University of Chicago Medical Center (UCMC) between 2016 and 2021. Cox regression was used to estimate the effects of race and adjusted for age, ethnicity, inpatient stays, metastatic breast cancer, marital status, and body mass index. Results The sample included 60.5% White, 3.6% Asian/Mideast Indian, 28.9% Black/African American, and 7.0% other or unknown race. Results indicate that code status orders after the first breast cancer encounter were uncommon (7.2%). Black/African American race (HR = 2.74; 95% CI: 1.75, 4.28) emerged as a significant factor associated with any code status orders compared to other race groups even when adjusting for covariates. Conclusions Code status documentation in this sample of women with breast cancer was low overall, yet rates were higher among Black/African American patients compared to other race groups. In fact, race remains a significant predictor of code status documentation even when accounting for indirect measures of cancer severity. This could be denoting the racial disparities (e.g., higher cancer malignancy such as triple negative breast cancer) in breast cancer mortality risk. Future research is needed to identify factors unique to Black/African American women that would increase code status documentation so that goal concordant care can be prioritized among patients with breast cancer.https://doi.org/10.1186/s12885-024-13132-6Code status ordersAdvance care planningBreast cancerRacial disparities |
| spellingShingle | Plamena P. Powla Heidy Medina Dario Villamar Clarissa Huard Julia Meguro Mariana Khawand-Azoulai Patricia I. Moreno Marcia M. Tan Racial disparities in the frequency and timing of code status orders among women with breast cancer BMC Cancer Code status orders Advance care planning Breast cancer Racial disparities |
| title | Racial disparities in the frequency and timing of code status orders among women with breast cancer |
| title_full | Racial disparities in the frequency and timing of code status orders among women with breast cancer |
| title_fullStr | Racial disparities in the frequency and timing of code status orders among women with breast cancer |
| title_full_unstemmed | Racial disparities in the frequency and timing of code status orders among women with breast cancer |
| title_short | Racial disparities in the frequency and timing of code status orders among women with breast cancer |
| title_sort | racial disparities in the frequency and timing of code status orders among women with breast cancer |
| topic | Code status orders Advance care planning Breast cancer Racial disparities |
| url | https://doi.org/10.1186/s12885-024-13132-6 |
| work_keys_str_mv | AT plamenappowla racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer AT heidymedina racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer AT dariovillamar racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer AT clarissahuard racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer AT juliameguro racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer AT marianakhawandazoulai racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer AT patriciaimoreno racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer AT marciamtan racialdisparitiesinthefrequencyandtimingofcodestatusordersamongwomenwithbreastcancer |