Palliative Care and EOL Care Utilization in Hospitalized Adults of Dharmic Religions with Cancer.

Abstract

Palliative care (PC) and end-of-life (EOL) care utilization for adults of Dharmic religions (DR; Hinduism, Buddhism, Sikhism, and Jainism) with cancer in the US is unknown. To measure PC utilization and EOL outcomes among hospitalized DR adults with cancer METHODS: We reviewed electronic health record (EHR) data for PC utilization and National Quality Framework (NQF)-endorsed EOL metrics at a dedicated cancer hospital and interviewed hospitalized DR patients and chaplains. Of 54,828 hospitalized adults, DR individuals (2.1% of study population) had higher PC utilization compared to non-DR (NDR) individuals (14.6% vs. 11.8%; p=0.004). In multivariate analysis, advanced illness (OR 18.57) was the strongest predictor of PC utilization. Compared to NDR individuals, DR individuals had higher inpatient deaths (27% vs 12%; p <.001), hospice enrollment ≤ 3 days before death (5% vs 2%; p = .021), chemotherapy use ≤ 14 days before death (11% vs 8%; p<.001), and ICU care ≤ 30 days before death (12% vs 5%; p<.001). Qualitative findings highlighted DR preferences for Ayurveda and dietary practices, the role of beliefs in coping with a cancer diagnosis, inconsistent communication of EOL preferences, and opportunities to improve care. For DR adults with cancer, PC is triggered by higher acute care utilization at the EOL. Interviews uncovered unmet socio-cultural needs. To improve outcomes, medical oncology and PC teams need to proactively address values across the cancer trajectory.