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


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.


CONCLUSIONS
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.
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY. rasharma@nmh.org.
Rashmi K
RK
Sharma
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
Kenzie A
KA
Cameron
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
Joan S
JS
Chmiel
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
Jamie H
JH
Von Roenn
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
Eytan
E
Szmuilowicz
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
Holly G
HG
Prigerson
Rashmi K. Sharma, Kenzie A. Cameron, Joan S. Chmiel, Jamie H. Von Roenn, Eytan Szmuilowicz, and Frank J. Penedo, Northwestern University, Chicago, IL; Jamie H. Von Roenn, American Society of Clinical Oncology, Alexandria, VA; and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
Frank J
FJ
Penedo
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D003953:Diagnosis-Related Groups; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*