Grant Number:	1R21CA139264-01 Interpret this number
Primary Investigator:	Barnato, Amber
Organization:	University Of Pittsburgh At Pittsburgh
Project Title:	Icu Triage Decisions for Elders with End Stage Cancer: the Role of Patient Race
Fiscal Year:	2009

DESCRIPTION (provided by applicant): One in five Americans die using intensive care (ICU) services despite a dominant cultural preference for dying at home. Blacks, especially those with cancer, are more likely to die in an ICU than whites, despite the fact that the majority of black elders have a preference against aggressive end-of-life treatment. For patients with end-stage cancer, seeking or deferring ICU admission is a critical single-event decision. While there is some evidence that blacks may be more likely to prefer aggressive life-sustaining treatment than whites, race-based differences in communication around end-of-life ICU use likely also contribute to existing disparities. Previous studies of physician decision making for common medical conditions have demonstrated race-based differences in diagnosis and treatment, ranging from overt prejudice, stereotyping and discrimination to the application of rules of conditional probability in the context of uncertainty. The goal of the proposed study is to enhance understanding of decision-making processes that impact end-of-life ICU use and factors which contribute to existing racial disparities in end-of-life ICU use. Our three specific aims are: 1) To test the effect of patient race on physician decisions to recommend ICU admission for a patient with end-stage cancer using high-fidelity simulation. 2) To test whether and how patient-provider communication mediates the effect of patient race on physician ICU admission decisions using qualitative content analysis of simulation encounters. 3) To explore the causes of race-based differences in ICU admission decision-making. A better understanding of physicians' decision-making processes and how they may contribute to a mismatch between patient preferences and end-of-life treatment could be used to design interventions to improve physician behavior. Public Health Relevance: The relevance of the proposed project to public health derives from a better understanding of how physicians contribute to racial variations in intensive care use at the end of life. The proposed project will be a success if can document differences in treatment decisions for black versus white simulated patients and generate hypotheses explaining these observed differences. Future work might include testing these hypotheses and developing educational modules for physicians aimed at improving their ability to make patient-centered decisions for critically ill patients with end-stage cancer.




Prudence in end-of-life decision making: A virtue-based analysis of physician communication with patients and surrogates.
Authors: Murphy A.C. , Schultz K.C. , Gao S. , Morales A.M. , Barnato A.E. , Fanning J.B. , Hall D.E. .
Source: Ssm. Qualitative Research In Health, 2022 Dec; 2, .
EPub date: 2022-10-26 00:00:00.0.
PMID: 36582622
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Key Physician Behaviors that Predict Prudent, Preference Concordant Decisions at the End of Life.
Authors: Morales A. , Murphy A. , Fanning J.B. , Gao S. , Schultz K. , Hall D.E. , Barnato A. .
Source: Ajob Empirical Bioethics, 2021 Oct-Dec; 12(4), p. 215-226.
EPub date: 2020-12-31 00:00:00.0.
PMID: 33382633
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Hospital-Based Physicians' Intubation Decisions and Associated Mental Models when Managing a Critically and Terminally Ill Older Patient.
Authors: Haliko S. , Downs J. , Mohan D. , Arnold R. , Barnato A.E. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2017-11-01 00:00:00.0; , p. 272989X17738958.
EPub date: 2017-11-01 00:00:00.0.
PMID: 29166565
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Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life.
Authors: Elliott A.M. , Alexander S.C. , Mescher C.A. , Mohan D. , Barnato A.E. .
Source: Journal Of Pain And Symptom Management, 2016 Jan; 51(1), p. 1-8.
PMID: 26297851
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The Language of End-of-Life Decision Making: A Simulation Study.
Authors: Lu A. , Mohan D. , Alexander S.C. , Mescher C. , Barnato A.E. .
Source: Journal Of Palliative Medicine, 2015 Sep; 18(9), p. 740-6.
PMID: 26186668
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Physicians' decision-making roles for an acutely unstable critically and terminally ill patient.
Authors: Uy J. , White D.B. , Mohan D. , Arnold R.M. , Barnato A.E. .
Source: Critical Care Medicine, 2013 Jun; 41(6), p. 1511-7.
PMID: 23552510
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A randomized trial of the effect of patient race on physicians' intensive care unit and life-sustaining treatment decisions for an acutely unstable elder with end-stage cancer.
Authors: Barnato A.E. , Mohan D. , Downs J. , Bryce C.L. , Angus D.C. , Arnold R.M. .
Source: Critical Care Medicine, 2011 Jul; 39(7), p. 1663-9.
PMID: 21460710
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