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Associations between Latino ethnicity and the use of emotional support and completion of advance directives

Published online by Cambridge University Press:  11 April 2023

Megan Johnson Shen Open the ORCID record for Megan Johnson Shen [Opens in a new window] ,
Holly G. Prigerson  and
Paul K. Maciejewski
Megan Johnson Shen*
Affiliation:
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
Holly G. Prigerson
Affiliation:
Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA Department of Medicine, Weill Cornell Medicine, New York, NY, USA
Paul K. Maciejewski
Affiliation:
Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA Department of Medicine, Weill Cornell Medicine, New York, NY, USA Department of Radiology, Weill Cornell Medicine, New York, NY, USA
*
Author for correspondence: Megan J. Shen, Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA. Email: mshen2@fredhutch.org
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Abstract

Objectives

Latino patients have been shown to engage in advance care planning (ACP) at much lower rates than non-Latino White patients. Coping strategies, such as the use of emotional support, may differentially relate to engagement in ACP among Latino and non-Latino patients. The present study sought to examine the moderating effect of ethnicity on the relationship between the use of emotional support as a coping strategy and completion of advance directives.

Methods

The present study employed a weighted sample (Nw = 185) of Latino and non-Latino White patient participants in Coping with Cancer III, an National Institutes of Health–sponsored, multisite, longitudinal, observational cohort study of patients with advanced cancer and their informal caregivers and oncology providers designed to evaluate Latino/non-Latino disparities in ACP and end-of-life cancer care. Main and interaction effects of Latino ethnicity and use of emotional support on patient use of advance directives were estimated as odds ratios.

Results

Use of emotional support was associated with dramatically lower do-not-resuscitate (DNR) order completion to a greater extent among Latino as compared to non-Latino patients (interaction AOR = 0.33, p = 0.005). Interaction effects were not statistically significant for living will or health-care proxy form completion.

Significance of results

Use of emotional support is associated with lower odds of completing DNRs among Latino than among non-Latino patients. Seeking and/or receiving emotional support may deter Latino patients from completing DNR orders. Research is needed to address both emotional needs and practicalities to ensure high quality end-of-life care among Latino patients with cancer.

Keywords

LatinoHealth disparitiesCopingDNR orderLiving willHealth-care proxyEnd-of-life care
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 3 , June 2023 , pp. 385 - 391
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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