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Barriers to Optimum End-of-life Care for Minority Patients

Authors

  • Eric L. Krakauer MD, PhD,

    1. Palliative Care Service, Massachusetts General Hospital, Boston, Massachusetts;
    2. Department of Social Medicine, Harvard Medical School, Boston, Massachusetts;
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  • Christopher Crenner MD, PhD,

    1. Department of History and Philosophy of Medicine, University of Kansas Medical School, Kansas City, Kansas; and
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  • Ken Fox MD

    1. Department of Social Medicine, Harvard Medical School, Boston, Massachusetts;
    2. Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
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Address correspondence to Eric L. Krakauer, MD, PhD, Palliative Care Service, Massachusetts General Hospital, 55 Fruit Street/Founders 600, Boston, MA 02114.

Abstract

Although major efforts are underway to improve end-of-life care, there is growing evidence that improvements are not being experienced by those at particularly high risk for inadequate care: minority patients. Ethnic disparities in access to end-of-life care have been found that reflect disparities in access to many other kinds of care. Additional barriers to optimum end-of-life care for minority patients include insensitivity to cultural differences in attitudes toward death and end-of-life care and understandable mistrust of the healthcare system due to the history of racism in medicine. These barriers can be categorized as institutional, cultural, and individual. Efforts to better understand and remove each type of barrier are needed. Such efforts should include quality assurance programs to better assess inequalities in access to end-of-life care, political action to address inadequate health insurance and access to medical school for minorities, and undergraduate and continuing medical education in cultural sensitivity.

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