The place of care can affect patients' access to palliative treatment

For end-of-life patients, palliative care can prolong survival and improve the quality of life of patients with life-threatening illness and their families. But studies have shown that racial and ethnic minorities are less likely to receive end-of-life palliative care than their counterparts. A new study conducted by investigators at Brigham and Women's Hospital aimed to understand why and revealed that the site of care could be a key contributor to this difference in patients with advanced and metastatic cancer . Their results are published in JAMA Network open now.

"Palliative care has a growing role to play and most physicians agree that many terminally ill cancer patients are referred for palliative care," said corresponding author, Quoc-Dien Trinh, MD, MD of the urological surgery division. the Brigham Center for Surgery and Public Health (CSPH).

"We knew that black and Hispanic patients receiving palliative care received less palliative care than white patients, but we did not know why, did not the doctors offer these services to their Black and Hispanic patients?" is there another factor at play? "said first author Alexander P Cole, MD, also of the Division of Urologic Surgery and CSPH.

In their study, Trinh, Cole and colleagues found that the odds of receiving palliative care among patients treated in some hospitals were only about two-thirds of those of patients receiving care in conventional hospitals. These tend to be hospitals that disproportionately treat minority patients.

"We find that the site of care seems to be a determining factor in determining whether or not a person is receiving palliative care," said Trinh.

The team conducted a retrospective, registry-based badysis of adults diagnosed with four types of metastatic cancer using data from the participant's use data files. National Cancer Database (NCDB). The team focused on men and women aged 40 and over with metastatic prostate cancer, non-small cell lung cancer, colon cancer, and bad cancer, four common and life-threatening cancers. The main outcome measured was the receipt of palliative care, such as pain treatment, surgical treatment, radiation therapy and systemic chemotherapy, administered to relieve symptoms but not to cure the disease.

The investigators looked at the hospitals where the patients were being cared for and calculated the proportion of patients belonging to a minority (black or Hispanic) treated in each of them. Hospitals with the largest proportion of minorities were considered "Minority Serving Hospitals" (MSH). Hospitals that were not among the top 10% were considered "minority hospitals" (non-MSH).

The team found that of the more than 600,000 people with metastatic cancer studied, 21.7% had received palliative care. A total of 22.5% of white patients (106,603) received palliative care, while only 20.0% of black patients (16,435 people) and 15.9% of Hispanic patients (3,551) received palliative care. palliative care. After adjusting for other variables, the team found that the odds of receiving palliative care were two-thirds of patients who received care in a MSH compared to those who received care in a MSH, regardless of the race or ethnicity of the patient.

"Our mission is to reduce inequities in health care, and the first step is to raise awareness of these disparities," Trinh said. "These findings suggest that there are significant racial and ethnic disparities in obtaining palliative care for patients with metastatic cancer and that these disparities are largely explained by the health care site." Hospitals can be an effective strategy for increasing the number of palliative care services provided to minorities.

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Brigham and Women's Hospital