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(Reuters Health) – A study suggests that patients may have less access to palliative care in US hospitals, primarily for minorities.
Researchers in the United States have noted in the JAMA Network Open that minorities in the United States often benefit from poorer health care and outcomes. The authors of the study tend to have less access to screening and recommended treatments, as well as lower chances of survival and less access to end-of-life palliative care.
"We knew that Black and Hispanic men and women with advanced cancer were less likely to receive palliative care, but we did not know why," said Dr. Alexander Cole, lead author of the study. Brigham and Women's hospitals and Harvard Medical School in Boston.
Palliative care aims to improve the quality of life of critically ill patients by relieving their symptoms and pain and relieving stress. This is increasingly a part of the treatment of cancer and other chronic and terminal diseases, as doctors and patients seek alternatives to aggressive treatment.
"With approximately 20% of US hospitals treating nearly 90% of minority patients, we decided to look at these" minority serving hospitals, "Cole said by email.
The researchers examined data on 601,680 patients with advanced lung, colon, bad and prostate cancer from 2004 to 2015 treated in 1,500 hospitals nationwide. Overall, about 22% received palliative care.
At first glance, race and ethnicity appeared to play a role: 23% of white patients had palliative care compared to 20% of black patients and 16% of Hispanic patients.
But the researchers then compared access to palliative care in the 150 hospitals with the largest number of non-white patients to what happened elsewhere. Patients treated in hospitals serving minorities were 33% less likely to receive palliative care, regardless of race or ethnicity.
"In other words, the significant racial and ethnic disparities in the reception of palliative care can largely be explained by the differences in the place where minority patients receive care," Cole said. email.
In total, 22% of patients received palliative care. In hospitals serving minorities, only 18% did so.
The type of tumor can also play a role, according to the study.
In the 1,500 hospitals combined, about 25% of lung cancer patients received palliative care, which fell to 19% for bad cancer, 15% for prostate tumors and 11% for colon cancer. .
Access to palliative care may be improving: patients treated in the last year of the study were 30% more likely to receive palliative care than those treated at the beginning. .
The study did not evaluate why some patients had received palliative care and others did not, or whether palliative care had directly influenced outcomes in cancer patients.
The researchers also relied on medical record data to determine which patients had received palliative care, which might not always be accurate, the study authors said.
Even in this case, the results show how much the local environment and health culture can 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 did not participate in the study.
Although this could not be determined from the data registry used for this study, the authors note that majority-serving hospitals are less likely to have health care programs in place. palliative, which suggests at a minimum a decrease in access to such care, but also probably decrease in notoriety, "Courtright said by e-mail.
It is therefore important for patients and their families to discuss their values and goals for care with clinicians, Courtright said.
"This discussion should at least include the option of a palliative care approach aimed at alleviating symptoms, minimizing suffering and optimizing quality of life, so that patients and their families can make a decision." truly informed treatment, "added Courtright.
SOURCE: bit.ly/2BlG0RW JAMA Network Open, released February 1, 2019.
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