Background: Geographic disparities in access to palliative care cause unnecessary suffering near the end-of-life in low-access U.S. states. The psychological mechanisms accounting for state-level variation are poorly understood. Objective: To examine whether statewide differences in personality account for variation in palliative care access. Design: We combined 5 state-level datasets that included the 50 states and national capital. Palliative care access was measured by the Center to Advance Palliative Care 2015 state-by-state report card. State-level personality differences in openness, conscientiousness, agreeableness, neuroticism, and extraversion were identified in a report on 619,387 adults. The Census and Gallup provided covariate data. Regression analyses examined whether state-level personality predicted state-level palliative care access, controlling for population size, age, gender, race/ethnicity, socioeconomic status, and political views. Sensitivity analyses controlled for rurality, nonprofit status, and hospital size. Results: Palliative care access was higher in states that were older, less racially diverse, higher in socioeconomic status, more liberal, and, as hypothesized, higher in openness. In regression analyses accounting for all predictors and covariates, higher openness continued to account for better state-level access to palliative care (b = 0.428, p = 0.008). Agreeableness also emerged as predicting better access. In sensitivity analyses, personality findings persisted, and less rural states and those with more nonprofits had better access. Conclusions: Palliative care access is worse in states lower in openness, meaning where residents are more skeptical, traditional, and concrete. Personality theory offers recommendations for palliative care advocates communicating with administrators, legislators, philanthropists, and patients to expand access in low-openness states.

57 Background: There are geographic disparities in access to palliative care that cause unnecessary suffering near the end of life in low-access U.S. states. The psychological mechanisms explaining state-by-state variation in access to palliative care are poorly understood. Our objective was to examine whether state-level differences in personality explain state-by-state variation in palliative care access. Methods: We combined four datasets with state-level data for the 50 U.S. states and the national capitol. Palliative care access was measured by the Center to Advance Palliative Care 2015 state-by-state report card. Statewide personality differences were identified from a report on 619,387 adults who completed the well-validated Big Five Inventory, which assesses the five core personality dimensions: openness, conscientiousness, agreeableness, neuroticism, and extraversion. The U.S. Census and Gallup provided data on covariates. Regression analyses examined whether state-level differences in personality predicted statewide access to palliative care, controlling for differences in population size, age, gender, race/ethnicity, socioeconomic status, and political views. Results: Access to palliative care was worse in states that were younger, more racially diverse, lower in socioeconomic status, more politically conservative, and lower in openness. In regression analyses that simultaneously accounted for all predictors and covariates, only lower openness continued to explain worse state-level access to palliative care (β = 0.428, p = 0.008). Conclusions: Palliative care access is worse in states where people are lower in openness, meaning residents who are more skeptical, traditional, and concrete. Personality theory offers specific recommendations for palliative care advocates communicating with hospital administrators, legislators, philanthropists, and patients to expand access in low-openness states.

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151 Background: Research has not thoroughly examined patient-level factors such as perceptions that could contribute to underutilization of palliative care, which may be due in part to a lack of existing measures for this purpose. Therefore, this investigation aimed to develop and validate a 9-item measure called the Palliative Care Preferences Scale (PCPS-9), which was comprised of three subscales: emotional, cognitive, and behavioral. Methods: Data were collected in three separate online studies of individuals with cancer (study 1: N = 633; study 2: N = 462) or one of the following non-cancer serious illnesses: COPD, heart failure, or kidney failure (study 3: N = 248). Analyses assessed various psychometric properties of the scale in cancer and non-cancer patients, including internal consistency reliability, confirmatory factor analyses (CFAs), multigroup CFAs, and convergent validity associations with related constructs. Results: Across all three studies, results supported the internal consistency reliability for the total scale (αs from 0.76 to 0.83) and subscales: emotional (αs from 0.83 to 0.84), cognitive (αs from 0.60 to 0.77), behavioral (αs from 0.87 to 0.91). CFAs supported the three-factor model of the PCPS-9 (CFI ≥ 0.97, NNFI ≥ 0.96, RMSEA ≤ 0.07, SRMR ≤ 0.04), and a multigroup CFA supported the generalizability of its factor structure across cancer and non-cancer serious illness subgroups (ΔCFIs ≤ 0.006, ΔRMSEA ≤ 0.003). Finally, convergent validity analyses in studies 2 and 3 found that the PCPS-9 was significantly associated with related constructs, including a separate measure of palliative care preferences ( ps < 0.001) and a measure of palliative care knowledge ( ps < 0.001). Conclusions: Findings support the overall reliability and validity of the PCPS-9 in cancer and non-cancer serious illness samples and have implications for increasing palliative care utilization via clinical care and future research efforts.