Context Intensive palliative care consultations for plan of care may reduce racial differences in end-of-life care. Objectives To compare cancer patients’ hospice referrals and code status changes after inpatient palliative care consultations by patient ethnicity and consultation intensity. Methods This observational cohort study prospectively recorded data for all adult cancer patients receiving palliative care consultations at the largest teaching hospital in Hawaii from 2005 through 2009. Chi-square analyses compared hospice referral and code status changes to “Do Not Attempt Resuscitation” by patient characteristics and consultation intensity (more intensive plan of care versus pain and/or symptom management without plan of care). Multiple logistic regression models analyzed factors associated with hospice referral and code status change. Results The 1362 consultations generated 454 (33.3%) hospice referrals and 234 (17.2%) code status changes. Controlling for age, gender, Karnofsky score and pre-consultation hospital days, Asian, Pacific Islander, and “other” ethnicities demonstrated increased likelihood of hospice referral versus whites (adjusted odds ratios [AOR] 1.46–2.34, P<0.05). Intensive plan of care consultations were strongly associated with hospice referral (AOR 3.08, 95% confidence interval [CI] 2.33–4.07, P<0.0001). Controlling for consultation intensity reduced the association between ethnicity and hospice referral (AORs 1.35–2.06, P=0.03, “other” ethnicity; P=nonsignificant, Asian and Pacific Islander). Intensive consultations were strongly associated with code status change (AOR 2.96; 95%CI 2.08–4.22, P<0.0001). Ethnicity was not significantly associated with code status change. Conclusion Consultation intensity was the strongest predictor of hospice referrals and code status changes, and reduced the ethnic variations associated with hospice referral.

The development of palliative care is in different stages across the surveyed countries/regions in the Asia-Pacific region. Data from this survey can be used as baseline data for monitoring the development of palliative care in this region.

Older cancer patients need at least the same levels of palliative care; while they experienced generally lower levels of nausea and pain, some older patients experienced higher levels of dyspnea, fatigue, emotional distress, need for information, help with decision making, loss of hope and pleasure, and independence.

Background: Pain management disparities exist among patients not receiving palliative care. We examined pain outcomes for disparities among patients receiving palliative care. Results: Study population included 4658 patients. No final pain was reported by more non-white patients (33%-39%) than white (27%, p < 0.0001) and more cancer and noncancer medical patients (45%-54%) than surgical/ other patients (20%-31%, p < 0.0001). Asian (adjusted odds ratio [aOR] 1.24; 95% confidence interval [CI] 1.06-1.46; p = 0.007) and PI (aOR 1.46, 95% CI 1.20-1.77, p = 0.0001) races had increased likelihoods of lower final pain severity versus whites, controlling for age, gender, Karnofsky score, preconsult length of stay, and initial pain severity. Surgical diagnoses had decreased likelihood of lower final pain levels versus cancer (aOR 0.38, 95% CI 0.32-0.46, p < 0.0001). Among 2304 patients reporting moderate/severe initial pain, 1738 (75.4%) reported pain reduction to mild/no final pain. PI race was associated with pain reduction versus whites (aOR 1.57, 95% CI 1.17-2.10, p = 0.003). Surgical diagnoses had decreased likelihood of pain reduction vs. cancer (aOR 0.52, 95% CI 0.39-0.71, p < 0.0001). Conclusion: Pain outcomes were similar or better among non-white races than whites. Surgical patients reported more final pain than cancer patients.

We conclude that 31 of 384 patients (8%) with advanced cancer receiving outpatient supportive care reported falls in the previous month. Patients with assistive devices, taking zolpidem, and with a higher MDAS score, and a positive delirium screening reported more frequent falls. Further studies are warranted.