Seeking Comforts, Seeking Cures: Racial Inequalities at the End-of-Life
Current research on racial differences and disparities at the end of life has focused on two puzzling phenomena - the increased spending in the last 6 months of life for racial minorities and mounting evidence that racial minorities and individuals with lower socioeconomic status report lower-quality end-of-life (EOL) experiences. These issues have broad implications for both an aging and diversifying US population and growing health care costs. In my dissertation, I explore potential explanations for both phenomena, drawing from but also challenging the current literature's hypotheses about appropriate versus aggressive end-of-life care and the role of advance care planning (ACP).
First, I examine whether I can better account for racial differences in ACP by taking into consideration trust in medical providers, the experience of discrimination, the experience of a serious health condition diagnosis for oneself or close relative, and health literacy, as well as racial differences in the relevance of these factors for ACP, using two nationally representative datasets (the Americans' Changing Lives Study and National Health and Aging Trends Study).
Second, I explore the processes that take place in EOL decisions, and how these processes are interpreted by surviving relatives in accounting for overall EOL experiences, using hospital observations and interviews. Qualitative methods offer additional insight into questions of whether and when preferences and/ or disparities influence racial differences in EOL experiences. My research will contribute to a better conceptual understanding of how inequalities arise in EOL experiences and relatedly, may offer insight into the potential effectiveness of interventions that hope to allay disparities and curb rising population level health care costs.
Funding Period: 09/01/2017 to 4/30/2018