New research from Columbia University School of Nursing published in the American Journal of Hospice and Palliative Medicine shows that timely goals of care discussions are less likely to take place in nursing homes with a higher percentage of Black residents.
These discussions are crucial to ensuring that nursing home residents receive care that aligns with their wishes, postdoctoral research fellow Jung A. "Chloe" Kang, PhD '24, Professor Patricia Stone, PhD, and their colleagues note in the report, published online September 15, 2024. But these conversations are often delayed until patients experience life-threatening events, the authors add, which can lead to unwanted therapies and unnecessary hospitalizations.
Black nursing home residents have worse end-of-life outcomes, especially for infection management. To investigate whether delays in discussing goals of care might be a factor, the researchers looked at the timing and frequency of goals of care discussions relating to infection management in 867 nursing homes across the U.S.
In the West, nursing homes with 2.1%-15% Black residents and those where more than 15% of residents were Black scored significantly worse on timely goals of care discussions compared to those with fewer than 2% Black residents. In the Northeast, nursing homes with 2.1%-15% Black residents also scored significantly lower on timely goals of care discussions than those with 2% or fewer Black residents.
Failing to have timely goals of care discussions about infection management can have "profound" implications, the authors warn. "Without these conversations, there may be an increased likelihood of either undertreatment or overtreatment, which can significantly affect the quality of life and dignity at the end-of-life," they write.
