Minority-serving hospitals may offer less palliative care

Treatment at minority-serving hospitals (MSHs) is associated with significantly lower odds of receiving palliative care, compared with treatment at a non-minority-serving hospital, according to new research published in JAMA Network Open

However, a patient’s race and ethnicity did not show an association with receiving palliative care, which is defined as comprehensive care that is given to patients with a serious illness, regardless of the diagnosis. It is typically not covered by Medicare and is focused on symptom relief.

“It is not known whether racial/ethnic differences in receipt of palliative care are attributable to different treatment of minorities or lower utilization of palliative care at the relatively small number of hospitals that treat a large portion of minority patients,” wrote lead author Quoc-Dien Trinh, MD, of Brigham and Women’s Hospital in Boston, and colleagues.

Trinh and colleagues sought to assess the association of receipt of palliative care among patients with metastatic cancer at minority-serving hospitals (MSHs), compared to non-MSHs.

Overall, they found, regardless of race or ethnicity, patients were 33 percent less likely to receive any palliative care for metastatic cancer at hospitals primarily serving minorities, according to a prepared statement.  

"Our mission is to reduce inequity in healthcare, and the first step in doing so is to raise awareness of these disparities,” Trinh said in the same statement. "These findings suggest that there are significant racial and ethnic disparities in receipt of palliative care for patients with metastatic cancer and that these disparities are largely accounted for by the site of a patient's care.”

Trinh et al. assessed the Participant Use Files of the National Cancer Database, consisting of data from all patients treated at more than 1,500 hospitals. They specifically collected data from patients older than 40 years with metastatic cancers—including prostate, lung, colon and breast cancer––who were diagnosed between January 1, 2004, and December 31, 2015. 

More than 601,600 patients at MSH and non-MSH facilities were used at the study cohort—of which 22 percent received palliative care and 78 percent did not. Patients with metastatic lung cancer received the most palliative care, compared to those with prostate, colon or breast cancer. Additionally, they found:

  • MSH patients were less likely to receive palliative care, compared to non-MSH patients, regardless of race or ethnicity.
  • Approximately 23 percent of white patients received palliative care, compared to 20 percent of black patients and 16 percent of Hispanic patients. 
  • After adjusting for other variables—including MSH status, cancer type, gender, age, race/ethnicity, year of diagnosis, insurance type and family income—patients who received care at an MSH had two-thirds the odds of receiving palliative care, compared to those who received care at a non-MSH, regardless of race of ethnicity.

Additionally, Hispanic patients had higher odds of palliative care compared with white patients. A lower number of Asian patients received palliative care, compared to non-Hispanic white patients. 

“After controlling for race/ethnicity and MSH status, we found that treatment at MSHs was associated with significantly lower odds of receiving palliative care, but black and Hispanic race/ethnicity was not,” the authors concluded. “Strategies that focus on improving palliative care use at MSHs may be an effective strategy to increase the receipt of palliative care for this population.”