Bringing Palliative Care To Underserved Rural Communities

Huff, Charlotte

doi:10.1377/hlthaff.2019.01470

Cited by 12 publications

(10 citation statements)

References 5 publications

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“…Patients living farther from their cancer provider may be more likely to live in a rural community and therefore receive cancer treatment at a smaller community hospital. Smaller community hospitals may be less likely to have palliative care programs in place, leading to the underutilization of palliative care services [ 40 ]. Future research evaluating rural and urban differences in palliative care use among cancer patients should be prioritized to optimize rural cancer care.…”

Section: Discussionmentioning

confidence: 99%

Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

Islam

Saraiya

Previs

et al. 2021

IJERPH

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Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.

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Section: Discussionmentioning

confidence: 99%

Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

Islam

Saraiya

Previs

et al. 2021

IJERPH

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“…Mounting evidence regarding the potential of alternative palliative care delivery models, such as telehealth, provides a potential solution for hospitals that cannot support a full specialty palliative care team. 19,20 Finally, this study sets a foundation for future research directions. Studies that identify the reasons for palliative care program closures, the specific motivators behind hospital adoption of programs, and further exploration as to why hospital ownership influences the development of palliative care are needed.…”

Section: Discussionmentioning

confidence: 84%

Factors Associated with the Adoption and Closure of Hospital Palliative Care Programs in the United States

Rogers

Meier

Moreno

et al. 2021

Journal of Palliative Medicine

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Background: In the United States, the percentage of hospitals over 50 beds with palliative care programs has risen substantially from 7% of hospitals in 2001 to 72% in 2017. Yet the dynamic nature of program adoption and closure over time is not known. Objective: To examine the rate of palliative care program adoption and closure and associated hospital and geographic characteristics in a national sample of U.S. hospitals. Design: Adoption and closure rates were calculated for 3696 U.S. hospitals between 2009 and 2017. We used multivariable logistic regression models to examine the association between adoption and closure status and hospital, geographic, and community characteristics. Setting/Subjects: All nonfederal general medical and surgical, cancer, heart, and obstetric or gynecological hospitals, of all sizes, in the United States in operation in both 2009 and 2017. Results: By 2017, 34.9% (812/2327) of the hospitals without palliative care in 2009 had adopted palliative care programs, and 15.0% (205/1369) of the hospitals with programs had closed them. In multivariable models, hospitals in metropolitan areas, nonprofit and public hospitals (compared to for-profit hospitals), and those with residency training approval by the Accreditation Council for Graduate Medical Education were significantly more likely to adopt and significantly less likely to close palliative care programs during the study period. Conclusions: This study indicates that palliative care is not equitably adopted nor sustained by hospitals in the United States. Federal and state interventions may be required to ensure that high-quality care is available to our nation's sickest patients.

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“…6,8 The use of telemedicine in otolaryngology has been previously described as a lifeline for patients during Hurricane Katrina, delivering compassionate care to palliative patients, and largely on a trial basis for rural or postoperative patients. [10][11][12] However, these experiences were in the context of barriers to care, such as natural disasters and large distances to care, and not necessarily addressing routine visits under normal circumstances. 13,14 Although the COVID-19 pandemic is similar to previous natural disasters with a disruption of standard operations, it differs from past natural disasters, such as Hurricane Katrina, in that it represents a situation where the normal infrastructure for the delivery of care is still in place.…”

Section: Discussionmentioning

confidence: 99%

“…The use of telemedicine in otolaryngology has been previously described as a lifeline for patients during Hurricane Katrina, delivering compassionate care to palliative patients, and largely on a trial basis for rural or postoperative patients 10–12 . However, these experiences were in the context of barriers to care, such as natural disasters and large distances to care, and not necessarily addressing routine visits under normal circumstances 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Telemedicine in Otolaryngology in the COVID‐19 Era: Initial Lessons Learned

2020

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Objectives/Hypothesis: The COVID-19 pandemic has led to unprecedented global changes in the delivery of healthcare over a short period of time. With the implementation of shelter-in-place orders, otolaryngology clinic visits at our institution were transitioned to telemedicine. This change enabled the rapid characterization of the patients who accepted and declined telemedicine. Study Design: Cross-sectional analysis. Methods: A review was conducted of 525 otolaryngology patients at a tertiary-care referral center with scheduled visits requiring rescheduling to a future date or a telemedicine visit. Visit, demographic information, and reason for deferring telemedicine were collected for analysis. Results: Seventy-two percent of patients declined a telemedicine visit, with the most common reason being the lack of a physical exam (97%). There was an even distribution of demographics between those who accepted and declined visits. There was an association between declining telemedicine with older age (P = .0004) and otology visits (P = .0003), whereas facial plastics patients were more likely to accept (P < .0001). Patients scheduled earlier during the pandemic were more likely to accept a visit with a median of 28 days from onset of shelter-in-place orders versus 35 for those who declined (P < .0001). Conclusions: We describe our initial experience with a transition to telemedicine, where the majority of patients would decline a virtual visit due to the lack of a physical exam. Although the future remains uncertain, telemedicine will continue to play a vital role in healthcare delivery. We believe that understanding our patient base gives critical insights that will help guide and improve virtual care to meet patients' needs.

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Bringing Palliative Care To Underserved Rural Communities

Abstract: House call: Susan McCammon (right), a surgeon and palliative medicine physician at the University of Alabama at Birmingham, regularly visits patients such as Janice Bass, shown with her dog, Abbey, to manage treatment and support advance care planning.

Cited by 12 publications

References 5 publications

Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

Factors Associated with the Adoption and Closure of Hospital Palliative Care Programs in the United States

Telemedicine in Otolaryngology in the COVID‐19 Era: Initial Lessons Learned

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