期刊论文详细信息
Cancers
Modifiers of and Disparities in Palliative and Supportive Care Timing and Utilization among Neurosurgical Patients with Malignant Central Nervous System Tumors
Gary Hsin1  Reena Thomas2  Michael Chuwei Jin3  Gordon Li3  Adela Wu3  Corinna Clio Zygourakis3  John Ratliff3 
[1] Department of Extended Care and Palliative Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA;Department of Neurology and Neurological Sciences, Stanford Health Care, Stanford, CA 94304, USA;Department of Neurosurgery, Stanford Health Care, Stanford, CA 94304, USA;
关键词: health inequities;    brain cancer;    spinal tumor;    advanced cancer;    racial diversity;    palliative care;   
DOI  :  10.3390/cancers14102567
来源: DOAJ
【 摘 要 】

Patients with primary or secondary central nervous system (CNS) malignancies benefit from utilization of palliative care (PC) in addition to other supportive services, such as home health and social work. Guidelines propose early initiation of PC for patients with advanced cancers. We analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities in access to and utilization of supportive services. We introduce a novel construct, “provider patient racial diversity index” (provider pRDI), which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider’s patient demographics and suggest a provider’s cultural sensitivity and exposure to diversity. Our analysis demonstrates low rates of PC, home health, and social work services among racial minority patients. Notably, Hispanic patients had low likelihood of engaging with all three categories of supportive services. However, patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses. This study suggests that prospective studies that examine potential interventions at the provider level, including diversity training, are needed.

【 授权许可】

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