Statewide Differences in Personality Associated with Geographic Disparities in Access to Palliative Care: Findings on Openness

Abstract

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.

Sociodemographic Disparities in Access to Hospice and Palliative Care: An Integrative Review

“…8,[20][21][22][24][25][26][27][28][30][31][32][33]37 Remaining studies included patients and caregivers, 19 providers, 34,36 patients, caregivers, and providers, 35 and state-level data, that is, U.S. states or counties. 23,29 Race and ethnicity demographics were rather homogenous across studies, with majority of participants being White or Caucasian, consistent with existing literature. Marginalized populations represented were most commonly Black, and Hispanic to a lesser extent.…”

“…37 All quantitative studies involved non-experimental designs (cross-sectional, observational, and correlational designs). Samples were primarily drawn from U.S. datasets [20][21][22][23]26,27,[29][30][31][32] and electronic medical records, 8,24,28,33 rendering high variability in sample sizes (range: 2-2,966,444). Average sample size for qualitative studies was 16 participants (range: 7-24).…”

Using Demographics to Predict Palliative Care Access in Inpatient Facilities in Rural North Carolina

“…In general, accessibility to palliative care, which is critical to cancer outcomes, is limited in geographic regions such as the southeastern United States 15‐17 . Aligning with these earlier findings, our study extends the current knowledge base by examining a region of the country with limited information available regarding inpatient palliative care access.…”

Geopersonality of Preventable Death in the United States: Anger-Prone States and Opioid Deaths

“…5,6 These geographic differences in personality may have emergent and contextual influences on local and regional cultures and are associated with political, social, and health-care outcomes including healthcare legislation and access to supportive care. 4,7,8 A state population's aggregate propensity toward anger may be of particular relevance to understanding why some states are disproportionately impacted by opioid overdose death. A state-level, opioid overdose rates could be increasing more rapidly over time in areas where frustration resulting from manufacturing job loss is experienced by a population with a greater aggregate propensity toward angry, irritable, hostile, and impulsive reactions to stress.…”