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Beliefs on Palliative, Hospice Care Influence Use in Advanced Lung Cancer Among Minorities


Racial disparities in palliative and hospice care beliefs appear to influence early integration in to standard oncologic care for patients with advanced lung cancer.

Minority patients with advanced lung cancer reported they are more likely to prefer palliative care rather than hospice and had less favorable beliefs about hospice care compared with non-minority patients, according to study results presented at the 2018 ASCO Annual Meeting.

Lung cancer is a disease that is often associated with a high morbidity and mortality rate, which is also increasingly reflective among racial and ethnic minorities.

“One of the things we know is that palliative and hospice care can be extremely helpful for patients with advanced cancer, and yet, racial and ethnic minorities often have higher morbidity and less report of medical care that is in line with their wishes,” Cardinale B. Smith, M.D., Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, said in an interview with CURE.

This can be addressed with the integration of palliative and hospice care, which, with early integration in to standard oncologic care for patients with advanced lung cancer, has proven to improve quality of life, mood and survival.

Since little is known about racial disparities in palliative and hospice care beliefs and the influence of these factors on the utilization of palliative care and hospice, Smith and colleagues conducted a prospective cohort study, as part of a larger study intended to enroll 160 patients. As part of the study, they set out to identify these differences among minority patients compared with non-minority patients, all with newly diagnosed stage 3 to 4 lung cancer receiving treatment in Mount Sinai’s cancer center.

Within three months of diagnosis, patients completed a validated survey designed to assess palliative and hospice care beliefs and care preferences. Responses to questions on beliefs were scored on a scale of 1-5, with 1 standing for strongly agree and 5 for strongly disagree.

The researchers have enrolled 97 of the 160 eligible patients (61 percent), of which 61 completed the survey. Among survey participants, 38 (62.3 percent) were minorities and 23 (37.7 percent) were non-minorities.

In regards to palliative care beliefs, minority patients reported feeling more hopeful and more secure with palliative care referral. However, they were also more likely to believe they cannot afford hospice and that it is not as good as the hospital for cancer care.

“What we found is that minority patients had false, less favorable beliefs about this compared with non-minorities; specifically, this belief that this would hasten their dying process or they wouldn’t be able to afford that kind of care,” Smith said. “It is really important for clinicians themselves to get educated on what hospice services are and how they can be provided, so they can better educate patients about it.”

In addition, minorities were less likely to believe that hospice care can be provided at home or that it can help with physical, psychological, social and spiritual needs. Moreover, a larger amount of minorities preferred palliative care to hospice care compared with non-minority patients.

“I expected (these results),” Smith said. “I just didn’t know how much minority patients knew about palliative care. Once we explained to them what it was, they were more likely to want that.”

Future studies in this area will be performed to see how these beliefs affect the use of palliative and hospice care services. “Our next step is to really look at how these change over time, and how minorities actually utilize palliative care services,” Smith said. “The ultimate goal is to really figure out how we can create culturally confident palliative care.”

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