Palliative Care Awareness and Misconceptions By Sexual Orientation: HINTS 2018 and 2024.

Abstract

Sexual minority individuals with serious illness experience persistent inequities in end-of-life care compared with their heterosexual counterparts, including reduced access to timely, high-value palliative care (PC). This study examined differences in PC awareness and misconceptions between U.S. sexual minority (lesbian, gay, and bisexual) and heterosexual adults. We analyzed nationally representative data from the 2018 Health Information National Trends Survey (HINTS) Cycle 2 and the 2024 HINTS 7. Sequential multivariable robust Poisson regression models were used to estimate prevalence ratios (PRs) for PC awareness and misconceptions. Models were progressively adjusted: Model 1 (unadjusted); Model 2 (demographics); Model 3 (demographics and socioeconomic factors); and Model 4 (demographics, socioeconomic, and health-related factors). The final analytic sample included 8,036 respondents, of whom 6.5% self-identified as sexual minorities. The prevalence of PC awareness was 44.5% among sexual minority adults and 39.6% among heterosexual adults (P = 0.29). Although unadjusted differences were not statistically significant, sexual minority adults demonstrated significantly higher PC awareness after adjustment for socioeconomic factors (Model 3: adjusted PR [aPR] = 1.23; 95% CI: 1.03-1.47) and health-related factors (Model 4: Apr = 1.22; 95% CI: 1.02-1.46). Among respondents reporting PC awareness, 20.5% of sexual minority adults and 23.1% of heterosexual adults reported PC misconceptions (P = 0.65), with no significant differences observed across all regression models. After accounting for socioeconomic and health-related differences, sexual minority adults demonstrated higher PC awareness but comparable levels of PC misconception relative to heterosexual adults. Future research should examine mechanisms underlying the PC awareness-utilization gap among sexual minority populations.