Context: Although many studies have documented problems in communication between
physicians and patients, few have focused on discussions regarding prognosis among community
dwelling patients with terminal illness.
Objective: To examine the association of patient race and financial status with patient and
clinician reports of discussions about prognosis.
Design: Cross-sectional survey.
Setting: Participants' homes.
Participants: Two hundred fourteen patients age 60 years or older seriously ill secondary
to congestive heart failure, chronic obstructive pulmonary disease, or cancer; and their primary
clinicians.
Main outcome measures: Patient/clinician agreement regarding discussions of prognosis.
Results: In adjusted analysis, patients and clinicians were more likely to agree that discussions
about prognosis had taken place when patients had a lower financial status (odds ratio
[OR] 2.26, 95% confidence interval [CI] 1.03–4.96), or were nonwhite (OR 2.56, CI 0.85–7.68),
compared to patients who had a higher financial status or were white. Agreement about prognosis
discussions was also more likely (adjusted OR 4.12, 95% CI 1.15–14.76) when patients
were younger (i.e., age < 80).
Conclusions: Among a cohort of seriously ill community-dwelling patients, patients and
clinicians were more likely to agree that discussions about prognosis had occurred when patients
were poorer and nonwhite. These findings contrast with the majority of studies examining
the relationship between race or income and patient-physician communication about
other end-of-life issues.
