State-level differences in personality and geographic disparities in access to palliative care: Findings on openness.

Abstract

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.

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

“…31,93 There are also geographic disparities in access to palliative care in United States, suggesting that access to such care is worse among more racially diverse, poorer, and more politically conservative states. 52 Overwhelming evidence, based on large national data sets, consistently and unequivocally points to major disparities in palliative care in the United States. 13,39,40,55,64 One retrospective cohort study of over 5 million hospitalizations of dialysis patients revealed that non-Hispanic Black and Hispanic patients were less likely than non-Hispanic White patients to receive palliative care services in the hospital.…”

“…After searching almost fourthly-thousand citations, 284 articles were included in our study, of which 147 were manuscripts that directly addressed end-of-life and hospice care, palliative care, as well as advance care planning and directives that include non-Hispanic Blacks. 4 …”

“… 31 , 93 There are also geographic disparities in access to palliative care in United States, suggesting that access to such care is worse among more racially diverse, poorer, and more politically conservative states. 52 …”

“…280 Receiving palliative care for people with serious illness, and hospice services for people approaching the end of life is no exception. 11 , 13 , 18 , 23 , 24 , 37 , 38 , 44 , 45 , 47 , 50 , 52 , 54 , 58 , 71 , 74 , 75 , 83 , 91 , 93 , 116 , 141 , 142 , 173 , 181 , 188 , 281 It is urgent that we understand and eliminate both disparities in serious illness care and disparities in end-of-life care. The story about race and palliative and hospice care in United States is very much the same story of racism in health care.…”

Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication

“…25-46 The racial disadvantage has also been documented throughout the literature for adults who receive specialized services, such as palliative care for people with serious illness or hospice services for people approaching the end of life. 17,47-72 The racial disparities persist into end-of-life care, particularly regarding communication and family needs. 73…”