Quality of death and end-of-life care among stroke patients: A comparative study of Mexican American and non-hispanic white surrogate decision makers.

Background: Racial and ethnic differences in patterns of end-of-life care have been previously reported, though there has been little work on the quality of end-of-life care in Mexican American (MA) stroke patients. Purpose: To compare surrogate decision maker reports of quality of death and end-of-life care among deceased MA and non-Hispanic White (NHW) stroke patients. Methods: Stroke patients and their surrogate decision makers were identified from an ongoing population-based cohort study in Nueces County, Texas, USA. Surrogates completed the Quality of End-of-Life Care (QEOLC, primary outcome) and the Quality of Death and Dying (QODD-1, secondary outcome) measures, both ranging 0-10 (10=better). Linear regression models with generalized estimating equations were used to assess ethnic differences in outcomes, adjusted for pre-specified covariates. Results: A total of 138 surrogates were enrolled for 113 deceased stroke patients (MA = 67, NHW = 46; median patient age 78 years; female: 53%; died in the hospital: 51%). Surrogates' median age was 60 years, and 75% were women. The overall QEOLC (Median=8.5; IQR 8,10) and QODD-1 scores (Median=10, IQR 8,10) were high. There was no ethnic difference on the QEOLC (0.03 ± 0.46, p = 0.95) or QODD-1 (-0.60 ± 0.54, p = 0.27) after adjustment. Conclusions: Surrogates in this community reported high quality of end-of-life care and death after stroke with no differences by ethnicity. The lack of disparity is a welcome finding, though more work in communities with lower acculturation and considering other aspects of end-of-life care is needed.