Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center

Azhar, Ahsan; Yennurajalingam, Sriram; Ramu, Aashraya; Zhang, Haibo; Haider, Ali; Williams, Janet L.; Dibaj, Seyedeh; Liu, Diane D.; Bruera, Éduardo

doi:10.1016/j.jpainsymman.2017.10.025

Cited by 8 publications

(5 citation statements)

References 24 publications

(19 reference statements)

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“…Our findings showed that people living in SED absorbed palliative care services when they could gain access to them, with demonstrable higher intensity of use, particularly with regards to outpatient and community-based services [ 13 , 42 , 46 , 63 ]. Additionally, our review suggests that patients also have a greater physical symptom burden [ 42 , 69 , 84 ], thus making the greater use of palliative care services unsurprising. However, an alternative explanation could be that services and existing resources are failing to meet the complex needs of people experiencing SED, thus leading to repeated consultations.…”

Section: Discussionmentioning

confidence: 94%

“…There were 3 studies exploring physical symptom burden [ 42 , 44 , 69 , 72 ].Lower income and education levels were generally associated with higher physical symptom burden, with pain being widely reported [ 42 , 69 ]. Poverty was also found to be associated with increased receipt of medication for pain, dyspnoea and emotional distress [ 72 ].…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies described what and how palliative care services were used [ 40 – 42 , 46 , 51 , 55 , 58 , 63 , 71 ]. The evidence shows that even when patients had equal access to palliative care services, differences in the uptake of these persisted across different indicators of socioeconomic status.…”

Section: Resultsmentioning

confidence: 99%

“…The literature shows that this is the case for both routine and non-routine care and across the different services offered by palliative care. For example, patients with either limited insurance (Medicaid) or no health insurance had more follow up appointments with a hospital palliative care service [ 42 ]. This finding persisted for universal, publicly funded health insurance systems.…”

Section: Resultsmentioning

confidence: 99%

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The end of life experiences of people living with socio-economic deprivation in the developed world: an integrative review

et al. 2022

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Background Those experiencing socioeconomic deprivation have poorer quality of health throughout their life course which can result in poorer quality of death – with decreased access to palliative care services, greater use of acute care, and reduced access to preferred place of care compared with patients from less deprived populations. Aim To summarise the current global evidence from developed countries on end-of-life experience for those living with socio-economic deprivation. Design Integrative review in accordance with PRISMA. A thorough search of major databases from 2010–2020, using clear definitions of end-of-life care and well-established proxy indicators of socio-economic deprivation. Empirical research describing experience of adult patients in the last year of life care were included. Results Forty studies were included from a total of 3508 after screening and selection. These were deemed to be of high quality; from a wide range of countries with varying healthcare systems; and encompassed all palliative care settings for patients with malignant and non-malignant diagnoses. Three global themes were identified: 1) multi-dimensional symptom burden, 2) preferences and planning and 3) health and social care interactions at the end of life. Conclusions Current models of healthcare services are not meeting the needs of those experiencing socioeconomic deprivation at the end-of-life. Further work is needed to understand the disparity in care, particularly around ensuring patients voices are heard and can influence service development and delivery.

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Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The end of life experiences of people living with socio-economic deprivation in the developed world: an integrative review

et al. 2022

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“…A study by Azhar et al evaluated access and referrals to specialty pain and palliative care services for patients with advanced cancers. 22 The authors observed that patients with limited or no insurance had significantly higher pain scores and tended to be young, single, non-white, and often on opioids. 22 These findings reinforce the barriers to access that hinder optimal chronic pain management, including lack of a well-trained and culturally competent workforce.…”

Section: Literature Reviewmentioning

confidence: 97%

Treatment Disparities Among the Black Population and Their Influence on the Equitable Management of Chronic Pain

2021

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Introduction: Growing evidence suggests disparities in the prevalence, management, progression, and outcomes of chronic, nonmalignant pain-related conditions, especially for African American patients. Objective: The purpose of this review is to explore studied causative factors that influence the management of chronic pain among African Americans, including factors that result in disparate care that may contribute to unfavorable outcomes. Methods: This narrative review is based on available literature published on this topic published within the last 10 years. Results: Assessment of chronic pain is multifaceted, often complicated by patient medical comorbidities and a complex set of biopsychosocial/spiritual/financial and legal determinants. These complexities are further exacerbated by a patient's race, by provider bias, and by structural barriers—all intersecting and culminating in disparate outcomes. Conclusions: A comprehensive analysis is needed to identify quality improvement interventions and to mitigate major barriers contributing to disparities in the management of chronic pain in the African American population.

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Application of Critical Race Theory in Palliative Care Research: A Scoping Review

Marcewicz¹,

Kunihiro²,

Curseen³

et al. 2022

Journal of Pain and Symptom Management

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Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center

Cited by 8 publications

References 24 publications

The end of life experiences of people living with socio-economic deprivation in the developed world: an integrative review

The end of life experiences of people living with socio-economic deprivation in the developed world: an integrative review

Treatment Disparities Among the Black Population and Their Influence on the Equitable Management of Chronic Pain

Application of Critical Race Theory in Palliative Care Research: A Scoping Review

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