Geographic Variation in Knowledge of Palliative Care Among US Adults: Findings From 2018 Health Information National Trends Survey

Abstract

Background: Public knowledge and awareness of palliative care (PC) is important to its effective use. However, it remains unclear whether the geographic variation in knowledge of PC exits in the United States. This study examined the national geographic variation in knowledge of PC. Methods: The study sample was obtained from the 2018 National Cancer Institute’s Health Information National Trends Survey. Basic knowledge of PC, goal concordant treatment, misconceptions, and primary information source of PC were compared across 4 census regions. Multivariable logistic regression was used to examine factors associated with awareness of PC among 9 census divisions. Results: A total of 3194 respondents (weighted sample size: 229 591 005) were included in this study. Overall, 29% of all respondents reported having knowledge of PC; 32.9% of those residing in Northeast had some knowledge of PC, followed by 30.8% in the South, 26.2% in Midwest, and 25.6% in West. By census divisions, respondents residing in 3 divisions were more likely to have PC knowledge (New England, odds ratio: 3.06, 95% CI: 1.48-6.32, P = .003; South Atlantic, odds ratio: 1.96, 95% CI: 1.15-3.35, P = .014; Pacific, odds ratio: 1.86, 95% CI: 1.12-3.09, P = .018) compared to those in the Mountain division. Conclusions: The variation of PC knowledge on census division and state level in 2018 was consistent with the real-world geographic disparities in the availability of PC programs. These findings represent an opportunity for minimizing the gap of geographic disparity by initiating strategic programs and promoting PC programs nationwide.

Actualizing Better Health And Health Care For Older Adults

“…Palliative care is an evidence-based model that improves outcomes for people with serious illness, but it is underused in many regions of the country, with generally poorer access in community-based settings and for some racial/ethnic minority groups. 47 Additional efforts are needed to expand access to and use of these services across settings and throughout the course of serious illness, regardless of prognosis. The National Academy for State Health Policy has documented improved care and reduced unnecessary costs for people with serious illness who used palliative care.…”

Patient, Caregiver, and Clinician Perceptions of Palliative Care that Influence Access and Use: A Qualitative Meta-Synthesis

“…Our findings are consistent with other health services research which has found that most individuals in the US are not aware of PC. 13,15 Moreover, new insights were discovered, revealing just how widespread the lack of non-PC clinician buy-in is to engage PC teams in the care of their patients. This is worrisome since clinicians are patients' primary sources of information, and current PC education strategies have been minimally effective.…”

“…There is a lack of PC knowledge in the US, with over 70% of the population stating they have no knowledge of PC. 13 The lack of PC knowledge is even more prevalent in minority populations. 14 PC misconceptions persist, such as associating PC with death, equating PC to hospice care, and believing that receiving PC requires stopping all other treatments.…”

Hospital-based evaluation of palliative care among patients with advanced cervical cancer: a cross-sectional study

“…However, a study on the general population of Northern Ireland showed that only 20% knew the accurate term, “palliative care” [ 26 ]. Similarly, only 29% of adults in the United States expressed good knowledge regarding palliative care [ 28 ]. In addition, only 29% of the patients reported good palliative care knowledge in Zimbabwe [ 29 ] and Saudi Arabia [ 30 ].…”

“…However, a study on the general population of Northern Ireland showed that only 20% knew the accurate term, "palliative care" [26]. Similarly, only 29% of adults in the United States expressed good knowledge regarding palliative care [28]. In addition, only 29% of the patients reported Table 3 Attitude of patients with advanced cervical cancer towards palliative care, 2019 (N) Items with a negative attitude towards palliative care; values for these items were reversed before analysis.…”