Health Care System Distrust, Race, and Surrogate Decision-Making Regarding Code Status

Area of Science:

• Gerontology
• Sociology
• Health Disparities

Background:

• Previous research indicates Black patients have a higher preference for life-sustaining treatments, like cardiopulmonary resuscitation, at end-of-life (EOL) compared to non-Hispanic White patients.
• Racial disparities in healthcare have led to proposed explanations involving distrust, particularly when surrogate decision-makers are involved for hospitalized older adults.

Purpose of the Study:

• To explore the code status preferences of surrogates for hospitalized older adults.
• To investigate the role of trust in healthcare systems as a factor influencing these surrogate preferences, particularly concerning race.

Main Methods:

• Secondary analysis of an observational study involving 350 patient/surrogate dyads from three Midwest hospitals.
• Assessment of surrogate distrust using the Revised Health Care System Distrust Scale.
• Inquiry into surrogate preference for either full code or do not resuscitate status for the patient.

Main Results:

• A significantly higher proportion of Black surrogates (62.4%) preferred full code status compared to White surrogates (38.3%).
• After adjusting for covariates, Black race remained significantly associated with a preference for full code status (aOR=2.13).
• No significant association was found between surrogate race and distrust in healthcare systems in bivariate or multivariable analyses.

Conclusions:

• Black race is associated with preferences for full code status, independent of healthcare system distrust.
• Differences in end-of-life care preferences may stem from factors beyond distrust, potentially related to race and cultural nuances.
• Further research is essential to comprehend the cultural complexities influencing end-of-life care preferences to ensure alignment with patient values.