Palliative care use and utilization determinants among patients treated for advanced stage lung cancer care in the community and academic medical setting

Abstract

Purpose Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers. Methods Between 2020 and 2021, advanced stage lung cancer patients ( n = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors. Results Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%). Conclusion Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-023-07649-y.

Association of patient socioeconomic status with outcomes after palliative treatment for disseminated cancer

“…Our findings are largely in line with previous literature that has demonstrated lower rates of palliative treatment among racial and ethnic minorities 53 as well as patients treated at academic medical centers 54 . Additionally, among prostate cancer patients minoritized communities were less likely to discuss or use hospice based palliative care compared with other populations 11 .…”

“…Additionally, patient-level attitudes and perceptions regarding the role of palliative treatment, hospice care and treatment near the end-of-life can also impact patient's decisions to seek palliative care and should be addressed. 53,54 We noted regional differences as well. Palliative treatment was higher in the Northeast and Midwest regions of the United States compared to the West and South.…”

“…Our findings are largely in line with previous literature that has demonstrated lower rates of palliative treatment among racial and ethnic minorities 53 as well as patients treated at academic medical centers. 54 Additionally, among prostate cancer patients minoritized communities were less likely to discuss or use hospice based palliative care compared with other populations. 11 These finding could be attributable to a combination of factors including the economics of reimbursement, inequities in treatments offered or requested, differences in communication or other structural and societal barriers to equitable access to health care at both the provider and patient level.…”

“…Additionally, patient‐level attitudes and perceptions regarding the role of palliative treatment, hospice care and treatment near the end‐of‐life can also impact patient's decisions to seek palliative care and should be addressed. 53 , 54 …”

“…Provider training and ability to initiate timely discussions regarding end‐of‐life care and decisions toward fostering positive quality‐of‐life through hospice or complementary supportive care is critical. Additionally, patient‐level attitudes and perceptions regarding the role of palliative treatment, hospice care and treatment near the end‐of‐life can also impact patient's decisions to seek palliative care and should be addressed 53,54 …”