Greater preferences for death in hospital and mechanical ventilation at the end of life among non-whites recently diagnosed with cancer

Abstract Purpose: Minority cancer patients receive more aggressive care near death. This may indicate low quality end-of-life (EOL) care if discordant with patient preferences. We investigated preferred potential place of death and preferences regarding use of mechanical ventilation in a cohort of Texas cancer patients.Methods: A population-based convenience sample of recently diagnosed cancer patients from the Texas Cancer Registry was surveyed using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about preferences regarding location of death and mechanical ventilation were the outcome measures of this investigation. Inverse probability weighting analysis was used to construct multivariable logistic regression examining the associations of covariates. Results: Of 1460 respondents, a majority (82%) preferred to die at home compared to 8% who preferred dying at the hospital. In total 25% of respondents expressed a preference for undergoing mechanical ventilation at the EOL. Adjusted analysis showed increased preference among Black (OR=1.81; 95% CI: 1.19-2.73) and other non-white, non-Hispanic race individuals (OR=3.53; 95% CI: 1.99-6.27) for dying at a hospital. Males, married individuals, those of higher education and poor self-reported health showed significantly higher preference for dying at home. Minority respondents of all non-white races were more likely to prefer mechanical ventilation at the EOL as were individuals who lived with another person at home. Conclusion: Minority cancer patients were more likely to express preferences coinciding with aggressive EOL care including dying at the hospital and utilizing mechanical ventilation. These findings were independent of other sociodemographic characteristics, including decisional self-efficacy.