Sociodemographic predictors of palliative care utilization across a mid-Atlantic healthcare system.

Abstract

e13736 Background: Patients with advanced (Stage III, IV) cancer have high symptom burden that significantly impacts patients’ quality of life. American Society of Clinical Oncology Guidelines recommend referring all patients with advanced cancer to specialized interdisciplinary palliative care to provide symptom management alongside active treatment. However, palliative care is underutilized for patients with advanced cancer in the US (~35% receive inpatient palliative care). Prior research demonstrates that utilization of palliative care differs based on sociodemographic characteristics. The current study examined palliative care utilization during inpatient visits across a Mid-Atlantic healthcare system. Methods: We extracted data for all inpatient encounters from 2020-2023 for patients diagnosed with advanced cancer in the tumor registry (n=8,180 encounters among 4,296 patients). We used generalized linear mixed effects models controlling for insurance, cancer stage, and hospital to identify factors associated with the likelihood of a patient receiving a palliative care encounter. Results: A majority (63.63%) of patients in our sample had at least one palliative care encounter. Analyses indicated that Black OR=1.49, 95% CI [1.32, 1.67] and Other/Unknown racial group patients OR=1.65, 95% CI [1.33, 2.04] were more likely to have a palliative care encounter relative to White patients, though Hispanic patients did not have a significant difference in likelihood. Older age was related to lower likelihood of palliative care encounters OR=0.90, 95% CI [0.83, 0.96], and male patients were significantly less likely to have a palliative care encounter than female patients OR = 0.45, 95% CI [0.25, 0.81]. However, a significant interaction indicated that as patients increased in age, female patients’ palliative care encounter likelihood decreases. Conclusions: Our study found that almost two-thirds of patients with advanced cancer in our system received inpatient palliative care; this rate is ~1.8 times higher than other published studies among advanced stage cancer. Consistent with other studies, we found that female patients were more likely to receive palliative care than male patients. Our findings that older age was related to lower likelihood of palliative care utilization was contrary to other research. Limitations include the lack of comorbidity data and reliance on demographic data from electronic records vs. self-report. Future research is needed to understand mechanisms for differences based on racial group, sex, and age. Generalized linear mixed effects model. Variable Odds Ratio, 95% CI Racial Group Non-Hispanic White Reference Non-Hispanic Black* 1.49 [1.32, 1.67] Hispanic 1.32 [0.99, 1.77] Other/Unknown* 1.65 [1.33, 2.04] Age at encounter Age (continuous)* 0.90 [0.83, 0.96] Sex Female Reference Male* 0.45 [0.25, 0.81] *Indicates statistical significance at p < .05.