End of Life Care for Racially and Ethnically Diverse PopulationsEnd of Life Care for Racially and Ethnically Diverse Populations

Gloria Ramsey, JD, RNGloria Ramsey, JD, RN

Associate Professor Graduate School of NursingAssociate Professor Graduate School of NursingAssociate Research Professor Associate Research Professor (nominee)(nominee) School of Medicine School of Medicine

Department of Medical and Clinical PsychologyDepartment of Medical and Clinical Psychology

Asked to ConsiderAsked to Consider

How to get started with a useful public policy How to get started with a useful public policy or educational initiative to improve care or educational initiative to improve care among underserved populations?among underserved populations?

Should the Council begin with a broad public Should the Council begin with a broad public engagement process? How would this best engagement process? How would this best be done?be done?

Would it be better to start a discrete project, Would it be better to start a discrete project, perhaps something that has been successful perhaps something that has been successful elsewhere? If so, what do you recommend?elsewhere? If so, what do you recommend?

Objectives…Objectives…

How to get started with a useful public policy How to get started with a useful public policy or educational initiative to improve care or educational initiative to improve care among underserved populations?among underserved populations?

– Identify healthcare disparities in Maryland among Identify healthcare disparities in Maryland among racial and ethnic minoritiesracial and ethnic minorities

Racial and Ethnic Health Racial and Ethnic Health DisparitiesDisparities

The problem of racial and ethnic The problem of racial and ethnic health disparities has been well health disparities has been well documented, leading the U.S. documented, leading the U.S. Department of Health and Human Department of Health and Human Services (HHS) to make eliminating Services (HHS) to make eliminating health disparities by 2010 a national health disparities by 2010 a national goal.goal.

Recent Headlines…Recent Headlines…

At the End of Life, a Racial DivideAt the End of Life, a Racial Divide

Minorities Are More Likely to Want Minorities Are More Likely to Want Aggressive Care, Studies ShowAggressive Care, Studies Show

Washington PostWashington Post

March 12, 2007March 12, 2007

……Recent Headlines…Recent Headlines…

A question of trustA question of trust

Hospice programs working harder to Hospice programs working harder to serve minority communitiesserve minority communities

The Boston GlobeThe Boston Globe

March 26, 2007March 26, 2007

……Recent HeadlinesRecent Headlines

Racial, Ethnic Cultural Differences Affect Racial, Ethnic Cultural Differences Affect Minorities’ Experience with Hospice Care, Minorities’ Experience with Hospice Care, Report FindsReport Finds

The Los Angeles TimesThe Los Angeles TimesMarch 16, 2007March 16, 2007

Much Much Speculation As Speculation As

to Why...to Why...

Racial and Ethnic Influences on Racial and Ethnic Influences on End-of-Life Preferences…End-of-Life Preferences…

Reluctance of blacks Reluctance of blacks and Hispanics to use and Hispanics to use hospicehospice services services (8% AA)(8% AA)

Reluctance of blacks Reluctance of blacks and Hispanics to and Hispanics to complete advance complete advance directivesdirectives (20% generally)(20% generally)

Reluctance of blacks Reluctance of blacks and Hispanics to and Hispanics to withdraw life-withdraw life-sustaining treatmentsustaining treatment

……Racial and Ethnic Influences on Racial and Ethnic Influences on End-of-Life PreferencesEnd-of-Life Preferences

Race/ethnicity is a predictor Race/ethnicity is a predictor of end of life decision-of end of life decision-making (even when adjust making (even when adjust for demographic and for demographic and socioeconomic status)socioeconomic status)

Religion/religiosity/spirit-Religion/religiosity/spirit-uality associated with uality associated with measures to prolong life, measures to prolong life, reluctance to withdraw life reluctance to withdraw life support, and disapproval of support, and disapproval of assisted suicideassisted suicide

Women are more likely Women are more likely to experience more to experience more pain and be pain and be undertreated for pain.undertreated for pain.

Women are less likely Women are less likely than men to prefer and than men to prefer and receive aggressive receive aggressive treatment at the end of treatment at the end of lifelife

Changing DemographicsChanging Demographics

The demographics of the nation are changing. The demographics of the nation are changing.

Past two or three decades remarkable increase in Past two or three decades remarkable increase in the diversity of our population. the diversity of our population.

Many people in the United States come from Many people in the United States come from Latin America, Eastern Europe, Southeast Asia, Latin America, Eastern Europe, Southeast Asia, and Africaand Africa

People of color make up one-third of the U.S. People of color make up one-third of the U.S. population, and that proportion is expected to population, and that proportion is expected to increase to half by 2050. increase to half by 2050.

              

  

              

  

              

  

Cardiac Disease Cancer Screening and Management Diabetes HIV Infections/AIDS Immunizations Infant mortality

Minority Populations are Disproportionately Affected

Objectives…Objectives…

How to get started with a useful public policy How to get started with a useful public policy initiative to improve care among underserved initiative to improve care among underserved populations?populations?

– Leverage and partner with others addressing Leverage and partner with others addressing healthcare disparities in Marylandhealthcare disparities in Maryland

Office of Minority Health and Health Disparities

The Office, located within DHMH, will: Provide public education forums Collect and analyze data Develop a strategic plan Provide grants to community-based organizations Develop outreach to racial and ethnic minority

communities Develop a plan to increase racial and ethnic minority

health care professionals Assist health care professional schools incorporate

courses on health disparities

House of DelegatesHouse of Delegates

HEALTH & GOVERNMENT OPERATIONS COMMITTEEHEALTH & GOVERNMENT OPERATIONS COMMITTEE The Health and Government Operations Committee was created in January 2003. The CommitteeThe Health and Government Operations Committee was created in January 2003. The Committeeconsiders legislation relating to child and elder healthcare; civil rights; emergency medical servicesconsiders legislation relating to child and elder healthcare; civil rights; emergency medical serviceshealth and life insurance; health policy and planning, including facilities, occupations and public health; health and life insurance; health policy and planning, including facilities, occupations and public health; health and life insurance; procurement; and State government. The Committee consists of twenty-fivehealth and life insurance; procurement; and State government. The Committee consists of twenty-fivemembers. It is supported by six subcommittees: Government Operations; Health Facilities and members. It is supported by six subcommittees: Government Operations; Health Facilities and Occupations; Insurance; Occupations; Insurance; Minority Health DisparitiesMinority Health Disparities; Pharmaceuticals; and Public Health and Long-Term ; Pharmaceuticals; and Public Health and Long-Term Care. Care.

MINORITY HEALTH DISPARITIES SUBCOMMITTEEMINORITY HEALTH DISPARITIES SUBCOMMITTEEThe Minority Health Disparities Subcommittee was created in September 2004.The Minority Health Disparities Subcommittee was created in September 2004.

MINORITY HEALTH DISPARITIES SUBCOMMITTEEMINORITY HEALTH DISPARITIES SUBCOMMITTEE

Appointed by Chair, Health & Government Operations Committee:Appointed by Chair, Health & Government Operations Committee:Shirley Nathan-PulliamShirley Nathan-Pulliam, , ChairChair (410) 841-3350, (301) 858-3350 (410) 841-3350, (301) 858-3350

Joanne C. BensonJoanne C. BensonJoseph C. Boteler IIIJoseph C. Boteler IIIWilliam J. FrankWilliam J. FrankSheryl Davis KohlSheryl Davis KohlSue KullenSue KullenShane E. Pendergrass Shane E. Pendergrass

Staff: Erin R. Hopwood (410) 841-3770, (301) 858-3770Staff: Erin R. Hopwood (410) 841-3770, (301) 858-3770

Copyright © 2006 by USU Center for Health Disparities Research and EducationCopyright © 2006 by USU Center for Health Disparities Research and Education