In an post published on GeriPal – a geriatric and palliative care blog – the doctor discusses the reasons for this, which he describes as “myriad.” And he also considers the role of the community health worker; a role he thinks can help to reduce the disparity and inequality seen all too often in end of life care.
He believes that “discussions between patients and providers regarding wishes for end of life care occur too infrequently or not at all.”
“Health care proxies often are not documented and advance directives remain unclear for a large percentage of patients with serious illness resulting in aggressive, expensive and often undesired care near the end of life,” he continues.
Dr Giftos also highlights the underuse of hospices. In his experience, if patients are referred to the specialist service, it is often very late in the dying process.
Organisations making progress are mentioned within the article, such as The Conversation Project, which among other things provides toolkits to help families talk with their loved ones about their wishes for end of life care. But Dr Giftos is keen to stress that despite this progress, some populations will continue to receive poor quality care:
“Communities of colour have long experienced suboptimal end of life care in this country. Although the data is old, evidence suggests that these patients remain less likely to have advance directives on file, are less likely to utilise hospice benefits and are more likely to die in the intensive care unit,” he writes.
The article explores this topic further as Dr Giftos considers notable recent improvements, such as health care reform expanding insurance cover and educational programs who “who more accurately reflect the population that they are serving.”
But he has an alternative idea: “Enter the community health worker.”
Dr Giftos references a recent article in the New England Journal of Medicine (NEJM), where authors Dr Prabhjot Singh and Dr Dave Chokshi describe the global success of community health workers. The NEJM article calls for a “scaling up” of the community health workforce as part of a national effort to improve health outcomes, reduce costs and create jobs.
The benefit of the community health worker role is subsequently described within the GeriPal blog, recognising their “appreciation for their community’s historical experience and values with an ability to understand, interpret and navigate complex health care systems” as key skills within palliative care.
And with a track record of working successfully in the fields of cancer and HIV, the doctor argues that community health workers are uniquely positioned to support “ongoing efforts to optimise end of life care for historically marginalised communities” and powerfully concludes that “community health workers have the potential to become powerful allies in reducing entrenched disparities in end of life care.”
You can read the full post at by Jonathan Giftos on GeriPal.