Racial Disparities and Mistrust in End-of-Life Care

TL;DR

This study investigates racial disparities and mistrust in end-of-life care using the MIMIC-III database, developing trust metrics that reveal stronger disparities and improve clinical task performance.

Contribution

The paper introduces novel trust metrics derived from clinical data and notes their stronger association with disparities than race alone.

Findings

Trust metrics show greater disparities than race.

Black patients exhibit higher mistrust levels.

Trust metrics improve clinical prediction performance.

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.).