Hospitals serving more minorities may offer less palliative care

[February 08, 2019]  By Lisa Rapaport

(Reuters Health) - Patients may have less access to palliative care at U.S. hospitals that primarily serve minorities, a study suggests.

Minorities in the U.S. often receive worse healthcare and have worse outcomes, researchers note in JAMA Network Open. Non-white cancer patients tend to have less access to screening and recommended treatments, and they also have worse survival odds and less access to palliative care at the end of life, the study authors add.

"We knew that black and Hispanic men and women with advanced cancer are less likely to receive palliative care, but we didn't know why," said lead study author Dr. Alexander Cole of Brigham and Women's Hospital and Harvard Medical School in Boston.

Palliative care aims to improve quality of life for seriously ill patients by relieving their symptoms and pain, and easing their stress. It has become an increasingly common part of treating cancer and other chronic and terminal illnesses as doctors and patients seek alternatives to aggressive treatment.

"Because about 20 percent of hospitals in the U.S. care for nearly 90 percent of minority patients, we decided to look at these 'minority-serving hospitals,'" Cole said by email.

Researchers examined data on 601,680 patients diagnosed with advanced lung, colon, breast and prostate cancers from 2004 to 2015 and treated at 1,500 hospitals across the country. Overall, about 22 percent received palliative care.

At first glance, race and ethnicity appeared to play a role: 23 percent of white patients got palliative care, compared with 20 percent of black patients and 16 percent of Hispanic patients.

But then researchers compared palliative care access at the 150 hospitals with the most non-white patients to what happened elsewhere. Patients treated at the minority-serving hospitals were 33 percent less likely to receive palliative care, regardless of race or ethnicity.

"In other words, the significant racial and ethnic disparities in receipt of palliative care may be largely explained by differences in where minority patients are receiving care," Cole said by email.

Overall, 22 percent of patients got palliative care. At minority-serving hospitals, only 18 percent did.

Tumor type may also play a role, the study found.

At all 1500 hospitals combined, about 25 percent of lung cancer patients received palliative care, this dropped to 19 percent with breast malignancies, 15 percent with prostate tumors and 11 percent with colon cancer.

Access to palliative care may be improving: patients treated in the last year of the study were 30 percent more likely to receive palliative care than those treated at the beginning.

The study did not assess why some patients got palliative care and others did not, nor whether palliative care directly influenced outcomes for cancer patients.

Researchers also relied on data from medical records to determine which patients received palliative care, and this might not always be accurate, the study authors note.

Even so, the results highlight how much the local healthcare environment and culture may influence medical practice in general, and access to palliative care in particular, said Dr. Kate Courtright, a researcher at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia who wasn't involved in the study.

"Although it could not be determined from the data registry used for this study, the authors note that predominantly minority-serving hospitals may be less likely to have established palliative care programs, which at a minimum suggests decreased access to such care, but also likely decreased awareness," Courtright said by email.

That makes it important for patients and families to discuss their values and goals for care with clinicians, Courtright said.

"That discussion must at least include the option for a palliative approach to care that focuses on alleviating symptoms, minimizing suffering and maximizing quality of life, so patients and families can make a truly informed treatment decision," Courtright added.

SOURCE: https://bit.ly/2BlG0RW JAMA Network Open, online February 1, 2019.

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