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, Frank J. Penedo

*Corresponding author for this work

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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 PCC 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% v41%; 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.

Original languageEnglish (US)
Pages (from-to)3802-3808
Number of pages7
JournalJournal of Clinical Oncology
Volume33
Issue number32
DOIs
StatePublished - Nov 10 2015

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Palliative Care
Inpatients
Referral and Consultation
Neoplasms
African Americans
Hispanic Americans
Hospices
Hospitalization Insurance
Hospice Care
Marital Status
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Sharma, Rashmi K. ; Cameron, Kenzie A. ; Chmiel, Joan S. ; Von Roenn, Jamie H. ; Szmuilowicz, Eytan ; Prigerson, Holly G. ; Penedo, Frank J. / Racial/ethnic differences in inpatient palliative care consultation for patients with advanced cancer. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 32. pp. 3802-3808.
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title = "Racial/ethnic differences in inpatient palliative care consultation for patients with advanced cancer",
abstract = "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 PCC 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{\%} v41{\%}; 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.",
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Racial/ethnic differences in inpatient palliative care consultation for patients with advanced cancer. / Sharma, Rashmi K.; Cameron, Kenzie A.; Chmiel, Joan S.; Von Roenn, Jamie H.; Szmuilowicz, Eytan; Prigerson, Holly G.; Penedo, Frank J.

In: Journal of Clinical Oncology, Vol. 33, No. 32, 10.11.2015, p. 3802-3808.

Research output: Contribution to journalArticle

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N2 - 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 PCC 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% v41%; 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.

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