Early Integration of Outpatient Palliative Care Among Adults With Advanced Cancer in a Safety-Net Health System: A Patterns of Care Analysis.

Abstract

Little is known about guideline-concordant, early integration of palliative care (PC) in the outpatient setting among patients with advanced cancer within a safety-net system. This study examined PC delivery patterns for patients seen in a large, urban safety-net system. Patients diagnosed with advanced-stage solid tumor and who had ≥1 outpatient oncology visit from January 2018 to July 2023 at Parkland Health were identified via electronic health record. Outcomes assessed included (1) receipt of PC referral ≤8 weeks after diagnosis, (2) receipt of any PC referral, and (3) PC visit completion. Multivariable logit models evaluated associations between key characteristics (age, race/ethnicity, gender, cancer type, preferred language, insurance, diagnosis year) and the outcomes. Among 1,296 patients (44% female; 76% non-White), 55% received a referral. Of those referred, 46% patients were referred early (≤8 weeks). Two thirds of the referred patients completed a PC visit during the study period. In adjusted regression models, patients who were Black (<i>v</i> White; adjusted odds ratio [aOR], 0.52 [95% CI, 0.33 to 0.82]), Hispanic (aOR, 0.33 [95% CI, 0.18 to 0.59]), or had prostate cancer (<i>v</i> breast cancer; aOR, 0.27 [95% CI, 0.10 to 0.69]) had lower odds of receiving early referral. Ages 40-69 (<i>v</i> >80 years; lowest odds for 60 to <70, aOR, 0.41 [95% CI, 0.20 to 0.85]) and patients with gynecologic cancer (aOR, 0.14 [95% CI, 0.07 to 0.28]) had lower odds of receiving any PC referral. Females had higher odds of completing a PC visit (<i>v</i> males; aOR, 1.45 [95% CI, 1.01 to 2.08]). Many patients did not receive an outpatient referral or received it late. Observed differences by race/ethnicity, cancer type, and age suggest the need for different interventions targeting PC delivery for underserved patients with cancer.