title: Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation.
abstract: BACKGROUND
  Differences among patient populations that present to consultative palliative care are not known. Such an appreciation would inform health-care delivery tailored to unique populations.
  
  
  OBJECTIVE
  We aimed to compare characteristics and palliative care needs of African Americans (AAs) and whites during initial palliative care consultation.
  
  
  METHODS
  We analyzed patient-reported, clinician-entered clinical encounter data from a large, multisite community-based, nonhospice palliative care collaborative. We included first specialty palliative care consultations from January 1, 2014, to July 2, 2015, across 15 sites within the Global Palliative Care Quality Alliance registry. Demographics, disease, performance status, advance care planning, and symptom prevalence/severity were compared.
  
  
  RESULTS
  Of 775 patients, 12.9% (N = 100) were AA. African Americans were younger (63 vs 75.4 years, P < .0001). A larger proportion of AAs had a diagnosis of cancer (45.0% vs 36.3%, P = .09) and in the hospital (71% vs 61.8%, P = .07). African Americans were more likely to have a Palliative Performance Score of 0 to 30 (35.6% vs 23.7%, P = .049). Around 50% in both racial groups were full code; slightly more than 40% had an advance directive. Nearly two-thirds in both racial groups reported 3 or more symptoms of any severity; one-third reported 3 or more moderate or severe symptoms. A larger proportion of Africans than whites reported pain of any severity (66.0% vs 56.1%, P = .06).
  
  
  CONCLUSIONS
  All patients present to palliative care consultations with significant symptom and advance care planning needs. Further research is needed to identify how to deliver palliative care: earlier, in noncancer conditions, and improve pain management in AA populations.
authors.affiliation: 1 Duke Cancer Institute, Durham, NC, USA.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.affiliation: 2 Four Seasons, Flat Rock, NC, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Bull
authors.affiliation: 3 Duke Department of Biostatistics, Duke University, Durham, NC, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Wolf
authors.affiliation: 4 Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Portman
authors.affiliation: 5 Mayo Clinic, Rochester, MN, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Strand
authors.affiliation: 6 Duke University, Durham, NC, USA.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Johnson
mesh_terms: D016223:Advance Directives / Q000208:ethnology; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000458:organization & administration*; D012720:Severity of Illness Index; D044465:White People
keywords: African Americans; disparities; health services; quality; service provision; unmet needs