Project 2: End-of-Life Care Among African-American Patients
Project 2 will identify patient, provider, and system-level factors that contribute to underuse of end-of-life (EOL) care among African-American patients hospitalized with life-limiting illness, and develop a culturally concordant, shared decision-making intervention to increase intention to consider EOL care options.
We will develop an EMR-based algorithm to systematically identify African-American patients hospitalized at Parkland Memorial Hospital with advanced cancer, AIDS, or cirrhosis who are appropriate candidates for a discussion about EOL care options according to national guidelines.
We will then perform the formative work with a broad range of stakeholders (patients, families, house staff, attendings, palliative care specialists, religious leaders) to customize and expand an existing mainstream EOL care decision aid to address key barriers to EOL care among the African-American community (e.g., spirituality, medical mistrust).
We will ultimately pilot a multicomponent intervention including real-time EMR identification of eligible patients, culturally concordant decision aid, and counseling by a culturally sensitive lay health coach.