Racial Disparities and Mistrust in End-of-Life Care

William Boag, Harini Suresh, Leo Celi, Peter Szolits, Marzyeh Ghassemi

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.).