Abstract
The Rosalind Franklin Society (RFS), in partnership with Mary Ann Liebert, Inc., publishers, enthusiastically congratulate our distinguished recipient of the 2023 annual
Shahla Siddiqui, Diana Bouhassira, Lauren Kelly, Margaret Hayes, Austin Herbst, Sarah Ohnigian, Luke Hedrick, Kimberly Ona Ayala, Daniel S. Talmor, and Jennifer P. Stevens, “Examining the Role of Race in End-of-Life Care in the Intensive Care Unit: A Single-Center Observational Study,” Palliative Medicine Reports 4, no. 1 (2023): 264–273, https://doi.org/10.1089/pmr.2023.0037.
Abstract
Background: Prior studies have shown variation in the intensity of end-of-life care in intensive care units (ICUs) among patients of different races.
Objective: We sought to identify variation in the levels of care at the end of life in the ICU and to assess for any association with race and ethnicity.
Design: An observational, retrospective cohort study.
Settings: A tertiary care center in Boston, MA.
Participants: All critically ill patients admitted to medical and surgical ICUs between June 2019 and December 2020.
Exposure: Self-identified race and ethnicity.
Main Outcome and Measure: The primary outcome was death. Secondary outcomes included “code status,” markers of intensity of care, consultation by the Palliative care service, and consultation by the Ethics service.
Results: A total of 9083 ICU patient encounters were analyzed. One thousand two hundred fifty-nine patients (14%) died in the ICU; the mean age of patients was 64 years (standard deviation 16.8), and 44% of patients were women. A large number of decedents (22.7%) did not have their race identified. These patients had a high rate of interventions at death. Code status varied by race, with more White patients designated as “Comfort Measures Only” (CMO) (74%) whereas more Black patients were designated as “Do Not Resuscitate/Do Not Intubate (DNR/DNI) and DNR/ok to intubate” (12.1% and 15.7%) at the end of life; after adjustment for age and severity of illness, there were no statistical differences by race for the use of the CMO code status. Use of dialysis at the end of life varied by self-identified race. Specifically, Black and Unknown patients were more likely to receive renal replacement therapy, even after adjustment for age and severity of illness (24% and 20%, p = 0.003).
Conclusions: Our data describe a gap in identification of race and ethnicity, as well as differences at the end of life in the ICU, especially with respect to code status and certain markers of intensity.
Biosketch
Dr. Siddiqui is a Board-certified Anesthesiologist and Intensivist with 20 years of clinical experience in academic medicine. She completed her residency at the University of Maryland and a Critical Care Medicine fellowship at Columbia University, NY in 2002. She has a special interest in medical ethics with a Masters from the National University of Singapore. She is currently Ethics faculty at the Harvard Medical School, Co-Chair of the Ethics Advisory Committee, and an Assistant Professor of Anesthesiology and Critical Care. She has had global experience practicing in University affiliated hospitals in Asia before working at Beth Israel Deaconess Medical Center. She has a research interest in humanities, racial disparities, burnout and medical ethics as well as a passion for medical education. Dr. Siddiqui has published several peer reviewed articles and chapters as well as have held multiple peer reviewed grants. She’s an ardent supporter of gender and URM academic and professional movements and is an active member of the American Society of Anesthesia’s Critical Care Medicine, DEI and Ethics Committees, SOCCA, SCCM, as well as the ASA Covid 19 Council. Her focus is on qualitative methodology and ethical reviews. She has been involved in helming educational, professional and research talks and webinars through the ASA and SCCM on pandemic related topics throughout 2020. Her work has been published and presented at numerous meetings. She has strived for academic excellence with multiple peer reviewed publications and has won the Healthcare delivery science grant (2021) and the John Hedley Whyte grant (2022). She has always been involved in raising the issues of disparate care and treatment of patients and staff in the ICU. As an ethicist and a member of the department and Society DEI committees her work has explored causes of racial and gender disparities.