Arif H Kamal1, Janet Bull2, Steven P Wolf3, Diane Portman4, Jacob Strand5, Kimberly S Johnson6. 1. 1 Duke Cancer Institute, Durham, NC, USA. 2. 2 Four Seasons, Flat Rock, NC, USA. 3. 3 Duke Department of Biostatistics, Duke University, Durham, NC, USA. 4. 4 Moffitt Cancer Center, Tampa, FL, USA. 5. 5 Mayo Clinic, Rochester, MN, USA. 6. 6 Duke University, Durham, NC, USA.
Abstract
CONTEXT: 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. OBJECTIVES: 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). CONCLUSION: 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.
CONTEXT: 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. OBJECTIVES: 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). CONCLUSION: 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.
Entities:
Keywords:
African Americans; disparities; health services; quality; service provision; unmet needs
Authors: Ronica Nanda; David Boulware; Rachid Baz; Diane Portman; H Michael Yu; Heather Jim; Peter A S Johnstone Journal: Acta Oncol Date: 2020-06-04 Impact factor: 4.089
Authors: Arif H Kamal; Janet Bull; Dio Kavalieratos; Jonathan M Nicolla; Laura Roe; Martha Adams; Amy P Abernethy Journal: J Palliat Med Date: 2016-06-27 Impact factor: 2.947