Racial Disparities and Mistrust in End-of-Life Care

Willie Boag, Harini Suresh, Leo Anthony Celi, Peter Szolovits, Marzyeh Ghassemi
Proceedings of the 3rd Machine Learning for Healthcare Conference, PMLR 85:587-602, 2018.

Abstract

There are established racial disparities in healthcare, including during end-of-life care, when poor communication and trust can lead to suboptimal outcomes for patients and their families. In this work, we find that racial disparities which have been reported in existing literature are also present in the MIMIC-III database. We hypothesize that one underlying cause of this disparity is due to mistrust between patient and caregivers, and we develop multiple possible trust metric proxies (using coded interpersonal variables and clinical notes) to measure this phenomenon more directly. These metrics show even stronger disparities in end-of-life care than race does, and they also tend to demonstrate statistically significant higher levels of mistrust for black patients than white ones. Finally, we demonstrate that these metrics improve performance on three clinical tasks: in-hospital mortality, discharge against medical advice (AMA) and modified care status (e.g., DNR, DNI, etc.).

Cite this Paper

BibTeX
@InProceedings{pmlr-v85-boag18a, title = {Racial Disparities and Mistrust in End-of-Life Care}, author = {Boag, Willie and Suresh, Harini and Celi, Leo Anthony and Szolovits, Peter and Ghassemi, Marzyeh}, booktitle = {Proceedings of the 3rd Machine Learning for Healthcare Conference}, pages = {587--602}, year = {2018}, editor = {Doshi-Velez, Finale and Fackler, Jim and Jung, Ken and Kale, David and Ranganath, Rajesh and Wallace, Byron and Wiens, Jenna}, volume = {85}, series = {Proceedings of Machine Learning Research}, month = {17--18 Aug}, publisher = {PMLR}, pdf = {http://proceedings.mlr.press/v85/boag18a/boag18a.pdf}, url = {https://proceedings.mlr.press/v85/boag18a.html}, abstract = {There are established racial disparities in healthcare, including during end-of-life care, when poor communication and trust can lead to suboptimal outcomes for patients and their families. In this work, we find that racial disparities which have been reported in existing literature are also present in the MIMIC-III database. We hypothesize that one underlying cause of this disparity is due to mistrust between patient and caregivers, and we develop multiple possible trust metric proxies (using coded interpersonal variables and clinical notes) to measure this phenomenon more directly. These metrics show even stronger disparities in end-of-life care than race does, and they also tend to demonstrate statistically significant higher levels of mistrust for black patients than white ones. Finally, we demonstrate that these metrics improve performance on three clinical tasks: in-hospital mortality, discharge against medical advice (AMA) and modified care status (e.g., DNR, DNI, etc.).} }
Endnote
%0 Conference Paper %T Racial Disparities and Mistrust in End-of-Life Care %A Willie Boag %A Harini Suresh %A Leo Anthony Celi %A Peter Szolovits %A Marzyeh Ghassemi %B Proceedings of the 3rd Machine Learning for Healthcare Conference %C Proceedings of Machine Learning Research %D 2018 %E Finale Doshi-Velez %E Jim Fackler %E Ken Jung %E David Kale %E Rajesh Ranganath %E Byron Wallace %E Jenna Wiens %F pmlr-v85-boag18a %I PMLR %P 587--602 %U https://proceedings.mlr.press/v85/boag18a.html %V 85 %X There are established racial disparities in healthcare, including during end-of-life care, when poor communication and trust can lead to suboptimal outcomes for patients and their families. In this work, we find that racial disparities which have been reported in existing literature are also present in the MIMIC-III database. We hypothesize that one underlying cause of this disparity is due to mistrust between patient and caregivers, and we develop multiple possible trust metric proxies (using coded interpersonal variables and clinical notes) to measure this phenomenon more directly. These metrics show even stronger disparities in end-of-life care than race does, and they also tend to demonstrate statistically significant higher levels of mistrust for black patients than white ones. Finally, we demonstrate that these metrics improve performance on three clinical tasks: in-hospital mortality, discharge against medical advice (AMA) and modified care status (e.g., DNR, DNI, etc.).
APA
Boag, W., Suresh, H., Celi, L.A., Szolovits, P. & Ghassemi, M.. (2018). Racial Disparities and Mistrust in End-of-Life Care. Proceedings of the 3rd Machine Learning for Healthcare Conference, in Proceedings of Machine Learning Research 85:587-602 Available from https://proceedings.mlr.press/v85/boag18a.html.

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