ADVANCE DIRECTIVES AND HEALTH DISPARITIES IN LUNG CANCER

Abstract

The purpose of this study is to explore associations between disparities in the documentation of advance directives in the medical records of patients with lung cancer. Consecutive medical records of patients newly diagnosed with LC between January 1, 2015 and June 30, 2016 were reviewed. Race, gender, age, geographic residence, stage of disease, insurance status, and presence of a living will were extracted. Descriptive statistics and fisher’s exact tests were used for analysis. The sample included 252 patients. Most patients were male (62.7%, n=158), over 60 years of age (80.2%, n=202), had stage IV disease (42.1%, n=106), lived in a rural area (50.4%, n=127), and had a smoking history (95.6%, n=241). African Americans comprised 33.7% (n=85) of the sample. Only 15.1% (n=38) of charts had a living will. No associations were found between living wills and gender, geographic location, stage of disease or insurance status. Living will documentation and race were significantly correlated (p=0.0007). African Americans were less likely to have a living will recorded. Living will documentation and age were also significantly correlated (p=0.0126). Older patients were more likely to have a living will recorded. Deceased patients were more likely to have a living will on record (84%, p=0.0398). Overall, documentation of living wills for these patients was sparse, especially among African Americans. For those with lung cancer, these findings suggest the need for more conversations about advance directives prior to periods of critical illness. In addition, tailoring these conversations to African Americans would help to lessen this disparity and improve outcomes for this vulnerable population.