Table 5.
Patient Characteristics Associated With Patient/Surrogate Report of EOL Discussion
| Characteristic | Unadjusted |
Adjusted* |
||||
|---|---|---|---|---|---|---|
| OR† | 95% CI | P | OR† | 95% CI | P | |
| Sex | .20 | .76 | ||||
| Male | Reference | Reference | ||||
| Female | 1.33 | 0.86 to 2.07 | 1.09 | 0.64 to 1.85 | ||
| Race/ethnicity | < .001 | .005 | ||||
| White | Reference | Reference | ||||
| Black | 0.41 | 0.23 to 0.73 | 0.37 | 0.19 to 0.73 | ||
| Asian | 0.84 | 0.28 to 2.52 | 1.33 | 0.38 to 4.68 | ||
| Hispanic | 0.19 | 0.09 to 0.41 | 0.29 | 0.12 to 0.73 | ||
| Other | 0.23 | 0.08 to 0.67 | 0.34 | 0.10 to 1.12 | ||
| Marital status | .17 | .04 | ||||
| Married/living as married | Reference | Reference | ||||
| Nonmarried | 1.37 | 0.88 to 2.13 | 1.73 | 1.02 to 2.94 | ||
| Age, years | 1.00 | 0.98 to 1.02 | .94 | — | ||
| Comorbidity score at diagnosis | .74 | |||||
| None | Reference | — | ||||
| Mild | 1.38 | 0.77 to 2.50 | — | |||
| Moderate | 1.33 | 0.69 to 2.54 | — | |||
| Severe | 1.23 | 0.65 to 2.35 | — | |||
| Speaks English in home | .02 | .46 | ||||
| Yes | Reference | Reference | ||||
| No | 0.30 | 0.11 to 0.85 | 0.59 | 0.15 to 2.35 | ||
| Education | .55 | |||||
| < High school | Reference | — | ||||
| High school/some college | 0.85 | 0.51 to 1.43 | — | |||
| ≥ College degree | 0.69 | 0.36 to 1.33 | ||||
| Income, $ | .60 | |||||
| < 20,000 | Reference | — | ||||
| 20,000-39,999 | 1.18 | 0.69 to 2.02 | — | |||
| 40,000-59,999 | 1.02 | 0.54 to 1.94 | — | |||
| ≥ 60,000 | 0.76 | 0.41 to 1.39 | — | |||
| Insurance | .047 | .48 | ||||
| Medicare | Reference | Reference | ||||
| Medicaid | 0.43 | 0.20 to 0.91 | 0.45 | 0.19 to 1.08 | ||
| Medicare plus private | 0.96 | 0.49 to 1.86 | 0.69 | 0.32 to 1.47 | ||
| Private | 1.12 | 0.54 to 2.35 | 0.75 | 0.32 to 1.73 | ||
| Other | 0.77 | 0.34 to 1.74 | 0.86 | 0.36 to 2.06 | ||
| HMO member | .01 | .03 | ||||
| Yes | Reference | Reference | ||||
| No | 0.51 | 0.30 to 0.86 | 0.40 | 0.18 to 0.90 | ||
| Study site | < .001 | .06 | ||||
| Five HMOs | Reference | Reference | ||||
| Eight counties in northern California | 0.45 | 0.19 to 1.03 | 0.82 | 0.28 to 2.38 | ||
| Alabama | 0.80 | 0.27 to 2.36 | 2.08 | 0.50 to 8.63 | ||
| Los Angeles County | 0.22 | 0.10 to 0.48 | 0.52 | 0.18 to 1.50 | ||
| Iowa | 0.58 | 0.25 to 1.30 | 1.07 | 0.33 to 3.42 | ||
| 23 counties in North Carolina | ‡ | ‡ | ||||
| 15 VA medical centers | 0.29 | 0.12 to 0.70 | 0.51 | 0.14 to 1.83 | ||
| Cancer type | .80 | |||||
| Lung | Reference | — | ||||
| Colorectal | 0.93 | 0.52 to 1.66 | — | |||
| Survival time from diagnosis, weeks | 1.00 | 0.99 to 1.02 | .47 | — | ||
| Baseline interview type | .04 | .03 | ||||
| Patient full | Reference | Reference | ||||
| Patient brief | 0.41 | 0.17 to 0.99 | 0.33 | 0.12 to 0.86 | ||
| Surrogate (living patient) | 2.35 | 0.77 to 7.21 | 2.30 | 0.70 to 7.54 | ||
| Surrogate (deceased patient) | 0.76 | 0.45 to 1.30 | 1.12 | 0.35 to 3.62 | ||
| Follow-up interview type | .14 | .21 | ||||
| Survivor | Reference | Reference | ||||
| Decedent | 2.66 | 0.77 to 9.12 | 3.10 | 0.79 to 12.1 | ||
| None | 1.77 | 0.54 to 5.80 | 1.73 | 0.33 to 9.12 | ||
NOTE. Of 634 patients with a documented discussion, 526 (83%) also had patient/surrogate report the discussion.
Abbreviations: EOL, end of life; HMO, health maintenance organization; OR, odds ratio.
*
Adjusted for variables with P < .20 on univariate analysis.
†
ORs and P values are from logistic regression.
‡
All North Carolina patients/surrogates recognized discussion.