Racial/Ethnic Differences in Inpatient Palliative Care Consultation for Patients With Advanced Cancer
- Rashmi K. Sharma⇑,
- Kenzie A. Cameron,
- Joan S. Chmiel,
- Jamie H. Von Roenn,
- Eytan Szmuilowicz,
- Holly G. Prigerson and
- Frank J. Penedo
+ Author Affiliations
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
- Corresponding author: Rashmi K. Sharma, MD, MHS, Division of Hospital Medicine, Northwestern University, 211 E Ontario St, 07-734, Chicago, IL 60611; e-mail: firstname.lastname@example.org.
Presented at the American Academy of Hospice and Palliative Medicine Annual Meeting, San Diego, CA, March 12-15, 2014, and at the Society of General Internal Medicine 36th Annual Meeting, San Diego, CA, April 23-26, 2014.
AS IS POSTED ON THIS BLOG AND MY WEB SITE AND IN A 40 MINUTE RADIO INTERVIEW, CANCER INCIDENCE AND DEATH RATE FOR THE MAJORITY OF CANCER IS WORSE IN MINORITIES. a lot OF MONEY FORM THE NCI , NIH AND AMER CAN SOC HAS GONE INTO FIGURING THIS OUT AND FIXING IT ,,,THIS IS A BREAKTHROUGH FINSDING- WHEN YOU PUR MINORITIES WITH TERMINAL CARE WITH ALL OTHERS- THEY DO BETTE OR AS WELL AS WHITES- WE ADDRESS THEIR NEEDS WELL, NOW LETS GET STRTAED ON REPEPATING THIS AND GETTING TO THE FACTOR THAT CAUSE THE DISPARITIES IN INCIDEDENCE AND DEATH RATE IN THE FIRST PLACE—AND WE WILL GET THERE DR RYAN
Purpose Inpatient palliative care consultation (IPCC) may help address barriers that limit the use of hospice and the receipt of symptom-focused care for racial/ethnic minorities, yet little is known about disparities in the rates of IPCC. We evaluated the association between race/ethnicity and rates of IPCC for patients with advanced cancer.
Patients and Methods Patients with metastatic cancer who were hospitalized between January 1, 2009, and December 31, 2010, at an urban academic medical center participated in the study. Patient-level multivariable logistic regression was used to evaluate the association between race/ethnicity and IPCC.
Results A total of 6,288 patients (69% non-Hispanic white, 19% African American, and 6% Hispanic) were eligible. Of these patients, 16% of whites, 22% of African Americans, and 20% of Hispanics had an IPCC (overall P < .001). Compared with whites, African Americans had a greater likelihood of receiving an IPCC (odds ratio, 1.21; 95% CI, 1.01 to 1.44), even after adjusting for insurance, hospitalizations, marital status, and illness severity. Among patients who received an IPCC, African Americans had a higher median number of days from IPCC to death compared with whites (25 v 17 days; P = .006), and were more likely than Hispanics (59% v 41%; P = .006), but not whites, to be referred to hospice.
Conclusion Inpatient settings may neutralize some racial/ethnic differences in access to hospice and palliative care services; however, irrespective of race/ethnicity, rates of IPCC remain low and occur close to death. Additional research is needed to identify interventions to improve access to palliative care in the hospital for all patients with advanced cancer.
Supported by the Robert H. Lurie Comprehensive Cancer Center of Northwestern University Director’s Fund, and by Grant No. K12-HD055884 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R.K.S.). Funding for biostatistical consultation was provided via the Robert H. Lurie Comprehensive Cancer Center’s Core Support Grant, Biostatistics Core No. P30-CA060553 (J.S.C.).