Journal Article

Palliative care use and utilization determinants among patients treated for advanced stage lung cancer care in the community and academic medical setting

McFarlin, Jessica, Shearer, Andrew, Studts, Jamie L., Shelton, Shaylla, Bursac, Vilma, Kiviniemi, Marc T., Mullett, Timothy, Borger, Tia, McLouth, Laurie E., Trice, Laura, Hoerger, Michael, Goebel, David, Stapleton, Jerod L., Thind, Ravneet, Schoenberg, Nancy E., Shelton, Brent

2023

Overview

Purpose Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers. Methods Between 2020 and 2021, advanced stage lung cancer patients ( n  = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors. Results Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%). Conclusion Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Advanced stage / Cancer / Cancer patients / Care and treatment / Clinical practice guidelines / Community / Community health care / Comparative analysis / Coping / Health care access / Health services utilization / Hospice and Palliative Care Nursing / Hospice care / Hospices / Hospices (Terminal care) / Humans / Insurance coverage / Intervention / Lung cancer / Lung Neoplasms - therapy / Medical centers / Medical colleges / Medical treatment / Medicine / Medicine & Public Health / Misconceptions / Nursing / Nursing Research / Oncologists / Oncology / Pain / Pain Medicine / Palliative Care / Palliative treatment / Patient communication / Patients / Physicians / Practice guidelines (Medicine) / Rehabilitation Medicine / Respiratory agents / Rural areas / Rural communities / Rural health care / Rural urban differences / Uncertainty / Urban health care