Social Inequalities in Palliative Care for Cancer Patients in the United States: A Structured Review.
Ronit Elk, Tisha M Felder, Ebru Cayir and 1 others
PMID 30146346WHAT IT FOUND
Palliative care access for cancer patients in the US varies widely by race, income, and location.
Black patients often face lower hospice use and higher symptom burden. Rural and immigrant groups encounter significant barriers to care, though telehealth shows promise for some populations.
Key findings
01Black/African American patients are generally less likely to receive palliative care services and experience greater symptom burden than white patients, though some studies show higher hospice referral rates.
02Patients enrolled in Health Maintenance Organizations (HMOs) receive hospice care at higher rates and earlier than those in Fee-For-Service (FFS) plans.
03Rural cancer patients often lack access to palliative care due to provider shortages, but telephonic nurse-led interventions have shown effectiveness in improving quality of life and mood.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included studies from 2007 to 2017, so some data may not reflect current healthcare policies or insurance landscapes. Many studies focused on end-of-life care rather than palliative care during active treatment, limiting understanding of earlier interventions. Definitions of 'low income' and 'vulnerable populations' varied across the included studies, making direct comparisons difficult. There is a lack of research on specific subgroups, such as American Indian/Alaskan Native patients and transgender individuals. Most evidence comes from quantitative administrative data, with few qualitative studies explaining the reasons behind disparities.
The easy way to misread this
Do not assume that all minority groups experience palliative care disparities in the same way. The evidence shows mixed results, such as higher hospice use among some Asian American subgroups and inconsistent findings for Black patients. Individual patient assessment remains essential.