Jincong Q Freeman, James L Li, Susan G Fisher, Katharine A Yao, Sean P David, Dezheng Huo
Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer
JAMA network open
background disparities found utilization palliative care pc however limitation existing research comingles factors affecting whether patient offered pc factors affecting whether patient acceptsrefuses pc objective identify determinants disparities neurosurgery patients acceptingrefusing inpatient pc provider recommends inpatient pc consult methodology singlecenter retrospective cohort study last 750 consecutive neurosurgery patient medical records screened inclusion criteria follows 1 patient seen neurosurgery service hospitalization 2 patient documented inpatient pc consult ordered patient least one progress note documenting pc plan care excluded patients seen neurosurgery service hospitalization pc consult order plan documented analysis performed using multivariate logistic regression backward stepwise variable selection candidate variables included age gender race ethnicity language marital status insurance type surrogate decisionmaker sdm relationship patient advanced directive charlson comorbidity index cci ambulation activities daily living adl dependence primary diagnosis category glasgow coma scale gcs time admission gcs time pc consult gcs time discharge duration hospitalization hospitalization mortality results last 750 neurosurgery patients study included 144 patients 333 female mean age 57531989 years among patients 109 patients 757 accepted pc 35 patients 243 refused pc univariate analysis showed patients refusing pc tended older p0003 shorter duration hospitalization p0023 chisquared analysis found associations pc acceptancerefusal preferred language p0026 religion p0001 sdm relationship patient p0004 multivariate logistic regression found predictors pc refusal older age or0965 p0049 nonenglish or0219 p0004 adult child sdm or0246 p0023 relativefriend sdm or0208 p0011 religious patients likely accept pc or7132 p0001 race ethnicity factors found significant predictors pc refusal black p0649 race p0189 hispanic p0525 conclusion nearly onequarter neurosurgery patients offered pc refused care predictors pc refusal older age nonenglish adult child sdm relativefriend sdm religious patients likely accept pc race ethnicity found significant predictors acceptingrefusing pc may suggest previously identified disparities stem minority patients offered less pc additional research needed replicate findings among different patient populations pc compatible lifeprolonging therapies aims provide additional emotional spiritual support patient family finding nearly onequarter patients refused pc may demonstrate pervasive misconception need patient education