Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

Abstract

Background: Advanced cancer patients often die in hospital after receiving needless, aggressive treatment. Although palliative care improves symptom management, barriers to accessing palliative care services affect its utilisation, and such disparities challenge the equitable provision of palliative care. This study aimed to identify which factors are associated with inequitable palliative care service utilisation among advanced cancer patients by applying the Andersen Behavioural Model of Health Services Use. Material and methods: This was a retrospective cohort study using administrative healthcare data. A total of 13,656 patients residing in the Lazio region of Italy, who died of an advanced cancer-related cause-either in hospital or in a specialised palliative care facility-during the period of 2012-2016 were included in the study. Potential predictors of specialised palliative service utilisation were explored by grouping the following factors: predisposing factors (i.e., individuals' characteristics), enabling factors (i.e., systemic/structural factors) and need factors (i.e., type/severity of illness). Results: The logistic hierarchical regression showed that older patients (odds ratio [OR] ¼ 1.45; <0.0001) of Caucasian ethnicity (OR ¼ 4.17; 0.02), with a solid tumour (OR ¼ 1.87; <0.0001) and with a longer survival time (OR ¼ 2.09; <0.0001) were more likely to be enrolled in a palliative care service. Patients who lived farther from a specialised palliative care facility (OR ¼ 0.13; <0.0001) and in an urban area (OR ¼ 0.58; <0.0001) were less likely to be enrolled. Conclusion:This study found that socio-demographic (age, ethnicity), clinical (type of tumour, survival time) and organisational (area of residence, distance from service) factors affect the utilisation of specialised palliative care services. The fact that service utilisation is not only a function of patients' needs but also of other aspects demonstrates the presence of inequity in access to palliative care among advanced cancer patients.

Trends, Sociodemographic and Hospital-Level Factors Associated With Palliative Care Utilization Among Multiple Myeloma Patients Using the National Inpatient Sample (2016-2018)

“…Previous studies have also suggested that older patients are more likely to receive palliative care. 30-32 However, Janah et al reported that younger cancer patients aged 18-49 were more likely to receive palliative care. 33 Regardless, there is evidence of benefit when palliative care is offered to patients early on in their disease rather than at the end of life.…”

Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review

“…Health inequities exist on several fronts, 7 8 including decreased access to preventative medicine, 9 higher burden of disease 3 and poorer access to assessment and treatment 10 as well as palliative care. 11 Similar trends are apparent within eyecare. [12][13][14][15] Black and Latinx people in the USA are less likely than white people to report having visited an eye care provider.…”

Palliative care service utilization and associated factors among cancer patients at oncology units of public hospitals in Addis Ababa, Ethiopia

“…This study was in agreement with the Italian study and Zimbabwe. In Italy, patients were more likely to use palliative care services if they lived less than 20 km from a facility that provided specialist palliative care [ 30 ]. Patients in Zimbabwe, who lived in closed distance from radiotherapy facilities had a higher likelihood of receiving palliative radiotherapy [ 31 ].…”