Racial/Ethnic Differences in Inpatient Palliative Care Consultation for Patients With Advanced Cancer

Abstract

Purpose: Inpatient palliative care consultation (IPCC) may help address barriers that limit the use of hospice and the receipt of symptom-focused care for racial/ethnic minorities, yet little is known about disparities in the rates of IPCC. We evaluated the association between race/ethnicity and rates of IPCC for patients with advanced cancer.

Patients and methods: Patients with metastatic cancer who were hospitalized between January 1, 2009, and December 31, 2010, at an urban academic medical center participated in the study. Patient-level multivariable logistic regression was used to evaluate the association between race/ethnicity and IPCC.

Results: A total of 6,288 patients (69% non-Hispanic white, 19% African American, and 6% Hispanic) were eligible. Of these patients, 16% of whites, 22% of African Americans, and 20% of Hispanics had an IPCC (overall P < .001). Compared with whites, African Americans had a greater likelihood of receiving an IPCC (odds ratio, 1.21; 95% CI, 1.01 to 1.44), even after adjusting for insurance, hospitalizations, marital status, and illness severity. Among patients who received an IPCC, African Americans had a higher median number of days from IPCC to death compared with whites (25 v 17 days; P = .006), and were more likely than Hispanics (59% v 41%; P = .006), but not whites, to be referred to hospice.

Conclusion: Inpatient settings may neutralize some racial/ethnic differences in access to hospice and palliative care services; however, irrespective of race/ethnicity, rates of IPCC remain low and occur close to death. Additional research is needed to identify interventions to improve access to palliative care in the hospital for all patients with advanced cancer.

Fig 1.

Kaplan-Meier estimates of survival according to severity of illness (N = 6,242). Severity of illness was assessed by the all-patient refined diagnosis-related group (APR) complexity score, which ranges from 1 to 4, indicating minor to extreme severity. Time 0 (index date) is the patient's first hospitalization during the study period.

Fig 2.

Kaplan-Meier estimates of survival by receipt of inpatient palliative care consult (IPCC; N = 6,242). Time 0 (index date) is the patient's first hospitalization during the study period.

Fig 3.

Kaplan-Meier estimates of survival according to race for patients who received an inpatient palliative care consult (n = 940). Time 0 (index date) is the patient's first hospitalization during the study period. AA, African American; NHW, non-Hispanic white.