Background: Palliative care is associated with increased patient satisfaction, a better understanding of symptoms and prognosis, and more family-centered care for cancer patients. However, knowledge of palliative care is limited and often physician referral occurs late in prognosis. Our objective was to describe predictors of palliative care knowledge and healthcare utilization in a U.S. population.
Methods: We analyzed data from the 2018 cross-sectional National Cancer Institute's Health Information National Trends Survey (HINTS) 5, Cycle 2. To assess respondents' level of knowledge of palliative care, we used the item “How would you describe your level of knowledge about palliative care?” with response options of “none”, “inadequate”, or “adequate”. Descriptive statistics were performed to determine the relationship between knowledge of palliative care and sociodemographic variables (race, age, gender, employment status, marital status, education, health insurance status, perception of health, recent checkup, regular source of care, cancer diagnosis, and cancer recurrence worry). Descriptive statistics and bivariate analyses were determined for the outcome of interest and independent variables. Multivariable logistic regressions, incorporating the sample weights, were conducted to identify the role of healthcare utilization controlling for relevant sociodemographic variables using odds ratios (OR) and 95% confidence intervals (CI). Jackknife replicate weights were used for population-level estimates. All analyses were conducted with survey commands using SAS 9.4 (SAS Institute Inc., Cary, NC, USA) and the significance level was set at p < .05.
Results: Among 3,504 study respondents, 2,995 (87%) had no knowledge of palliative care. The respondents included 65% Whites (n=1,961), 10.7% Blacks (n=432), and 15.8% Hispanics (n=453); 60% (n=2,542) of all respondents were 45 years or older. Female sex (vs male; OR =2.15, 95% CI = 1.31-3.59), being married (vs. single; OR= 2.02, 95% CI = 1.14-3.59), having a college degree or higher (vs. less than high school; OR= 13.83, 95% CI = 1.71-112.04) were demographics predictive of higher odds of palliative care knowledge. Healthcare utilization including frequent doctor visits (vs. one time or less; OR= 3.01, 95% CI = 2.65 - 3.58) and regular source of care (OR= 2.67, 95% CI = 1.37-1.90) were associated with increased odds of self-reported adequate knowledge of palliative care. Those without a personal history of cancer (OR= 0.49, 95% CI = 0.41-0.89) had lower odds of self-reported palliative care awareness.
Conclusions: Knowledge levels of palliative care were low in the U.S; more efforts are needed to fill these knowledge gaps. The modifiable variables that were predictive of palliative care knowledge were healthcare utilization and regular source of care. These factors could be considered when designing specific interventions to improve palliative care awareness.
Citation Format: Motolani E. Ogunsanya, Lauren O' Connor, Oluwatomi Iken, Paulette D. Chandler. Predictors of palliative care knowledge: Findings from the Health Information National Trends Survey [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5759.