Preference for Palliative Care in Cancer Patients: Are Men and Women Alike?

Saeed, Fahad; Hoerger, Michael; Norton, Sally A.; Guancial, Elizabeth A.; Epstein, Ronald M.; Duberstein, Paul R.

doi:10.1016/j.jpainsymman.2018.03.014

Cited by 84 publications

(69 citation statements)

References 36 publications

(54 reference statements)

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“…This corroborates the few studies that have already demonstrated differences in symptom management medication receipt by age, sex, and race/ethnicity, while controlling for symptom severity. 41,42 Although the symptom experience may vary across these dimensions, gaps in access, communication, or even provider bias may also contribute to these patterns. 43,44 The complexity of the relationships between patient symptom experience, reporting to providers, provider prescribing behavior, medication receipt, and adherence highlights the need for further research in these areas.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Saphire¹,

Prsic²,

Canavan³

et al. 2020

Journal of Pain and Symptom Management

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Context.-Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. Objectives.-We examined patterns of symptom management medication receipt at EOL for older adults who died of lung cancer. Methods.-This retrospective cohort used the Surveillance, Epidemiology, and End Results-Medicare database to identify decedents diagnosed with lung cancer at age 67 years and older between January 2008 and December 2013 who survived six months and greater after diagnosis. Using Medicare Part B and D claims, we identified monthly receipt of outpatient medications for symptomatic management of pain, emotional distress, fatigue, dyspnea, anorexia, and nausea/ vomiting. Multivariable logistic regression estimated associations between medication receipt and patient demographic characteristics, comorbidity, and concurrent therapy. Results.-Of the 16,246 included patients, large proportions received medications for dyspnea (70.7%), pain (62.5%), and emotional distress (49.4%), with lower prevalence for other symptoms. Medication receipt increased from six months to one month before death. Women and dual Medicaid enrolled were more likely to receive medications for pain, emotional distress, dyspnea, and nausea/vomiting. Receipt of symptom management medications decreased with increasing age and racial/ethnical minorities. Conclusion.-Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patientprovider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.

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Section: Discussionmentioning

confidence: 99%

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Saphire¹,

Prsic²,

Canavan³

et al. 2020

Journal of Pain and Symptom Management

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“…US-based research has consistently found that women are more likely than men to be enrolled in hospice which is seemingly related to both provider and patient bias. 65 – 69 Saeed and colleagues 67 found that, among 383 patients with metastatic cancer, women were three times more likely than men to consider palliative care, even when controlling for disease factors, age, race, education and financial strain. The study authors explained the results as follows: there is a societal norm that men are supposed to be tough and invulnerable and there is a lot of vulnerability in seeking help and focusing on comfort care instead of always being in fighter mode.…”

Section: Gender and Hospice And Specialist Palliative Carementioning

confidence: 99%

Gender and palliative care: a call to arms

2020

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There has been a systematic and largely unconscious neglect of gender in palliative care research, practice and policy. This is despite significant, although previously uncollated, evidence that gender influences almost all aspects of end-of-life preferences, experiences and care. The social situations of women, transgender people and men often differ from one another while also intersecting in complex ways with sex differences rooted in biology. If palliative care is to meet its aspiration of providing universal benefit, it urgently needs to address a range of gender inequalities currently (re)produced at the level of the laboratory all the way through to government departments. In this call to arms, we spotlight specific instances where gender inequalities have been documented, for example, regarding end-of-life caregiving, end-of-life intervention and palliative care access and benefit. We highlight how gender inequalities intersect with other social determinants of health including ethnicity and economic status to exacerbate situations of marginality. We conclude by offering some practical steps that can be taken to support the discipline to adopt a more critical gender lens to support more equitable research, policy and practice.

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“…Sex-and gender-considerations are important in both SDM itself and SDM implementation interventions. Sex and gender are important variables for decision making styles, communication styles, and values and preferences-all key issues in SDM [31][32][33][34][35]. Health professionals' sex and gender awareness will also impact their ability to identify risk factors for various illnesses, variables that may affect treatment options and their implications [36].…”

Section: Plos Onementioning

confidence: 99%

Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review

Adisso

Zomahoun²,

Gogovor³

2020

PLoS ONE

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Background Shared decision making (SDM) in healthcare is an approach in which health professionals support patients in making decisions based on best evidence and their values and preferences. Considering sex and gender in SDM research is necessary to produce precisely-targeted interventions, improve evidence quality and redress health inequities. A first step is correct use of terms. We therefore assessed sex and gender terminology in SDM intervention studies.

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Preference for Palliative Care in Cancer Patients: Are Men and Women Alike?

Abstract: Significant gender differences in patients' preferences for palliative care could partially account for gender disparities in end-of-life care. Interventions to promote palliative care among men could reduce these disparities.

Cited by 84 publications

References 36 publications

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Gender and palliative care: a call to arms

Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review

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