Utilization of supportive and palliative care services among oncology outpatients at one academic cancer center: Determinants of use and barriers to access

Pallavi Kumar, David Casarett, Amy Corcoran, Krupali Desai, Qing Li, Jinbo Chen, Corey Langer, Jun J. Mao

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Cancer causes significant symptom burden and diminished quality of life. Despite the expansion of supportive and palliative care services (SPCS), little is known about rates of utilization and barriers to access to these services among oncology outpatients. Methods: We performed a cross-sectional survey in three outpatient medical oncology clinics. Patients with a diagnosis of breast, lung, or gastrointestinal (GI) cancer and a Karnofsky score of ≥60 were included. Patients reported their use of SPCS and any perceived barriers. Multivariable logistic regression was used to identify factors associated with SPCS use. Results: Among 313 participants, (50.5%) had not used SPCS since cancer diagnosis. The most common services used were nutrition (26.5%), psychiatric/psychological counseling (29.7%), and physical therapy (15.1%). Pain/palliative care and cancer rehabilitation consultations were used by 8.5% and 4.1% of participants, respectively. In multivariate analysis, graduate education was associated with greater SPCS use (adjusted odds ratio [AOR] 2.14, 95% confidence interval [CI] 1.08-4.26) compared with those with high school or less, whereas having lung cancer was associated with less SPCS use (AOR 0.48, 95% CI 0.24-0.96) when compared with those having breast cancer. The biggest reported barriers to using SPCS were a lack of awareness (22.4%) and lack of physician referral (23%). Conclusions: Approximately half of these patients had not accessed SPCS since cancer diagnosis and cite lack of awareness and physician nonreferral as barriers. Further research is needed to understand patients' needs and beliefs regarding SPCS, and how to integrate SPCS into conventional treatments to improve cancer care.

Original languageEnglish (US)
Pages (from-to)923-930
Number of pages8
JournalJournal of palliative medicine
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2012

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Palliative Care
Outpatients
Neoplasms
Lung Neoplasms
Referral and Consultation
Odds Ratio
Confidence Intervals
Graduate Education
Breast Neoplasms
Physicians
Gastrointestinal Neoplasms
Medical Oncology
Psychiatry
Counseling
Rehabilitation
Multivariate Analysis
Cross-Sectional Studies
Logistic Models
Quality of Life
Psychology

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

Kumar, Pallavi ; Casarett, David ; Corcoran, Amy ; Desai, Krupali ; Li, Qing ; Chen, Jinbo ; Langer, Corey ; Mao, Jun J. / Utilization of supportive and palliative care services among oncology outpatients at one academic cancer center : Determinants of use and barriers to access. In: Journal of palliative medicine. 2012 ; Vol. 15, No. 8. pp. 923-930.
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abstract = "Background: Cancer causes significant symptom burden and diminished quality of life. Despite the expansion of supportive and palliative care services (SPCS), little is known about rates of utilization and barriers to access to these services among oncology outpatients. Methods: We performed a cross-sectional survey in three outpatient medical oncology clinics. Patients with a diagnosis of breast, lung, or gastrointestinal (GI) cancer and a Karnofsky score of ≥60 were included. Patients reported their use of SPCS and any perceived barriers. Multivariable logistic regression was used to identify factors associated with SPCS use. Results: Among 313 participants, (50.5{\%}) had not used SPCS since cancer diagnosis. The most common services used were nutrition (26.5{\%}), psychiatric/psychological counseling (29.7{\%}), and physical therapy (15.1{\%}). Pain/palliative care and cancer rehabilitation consultations were used by 8.5{\%} and 4.1{\%} of participants, respectively. In multivariate analysis, graduate education was associated with greater SPCS use (adjusted odds ratio [AOR] 2.14, 95{\%} confidence interval [CI] 1.08-4.26) compared with those with high school or less, whereas having lung cancer was associated with less SPCS use (AOR 0.48, 95{\%} CI 0.24-0.96) when compared with those having breast cancer. The biggest reported barriers to using SPCS were a lack of awareness (22.4{\%}) and lack of physician referral (23{\%}). Conclusions: Approximately half of these patients had not accessed SPCS since cancer diagnosis and cite lack of awareness and physician nonreferral as barriers. Further research is needed to understand patients' needs and beliefs regarding SPCS, and how to integrate SPCS into conventional treatments to improve cancer care.",
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Utilization of supportive and palliative care services among oncology outpatients at one academic cancer center : Determinants of use and barriers to access. / Kumar, Pallavi; Casarett, David; Corcoran, Amy; Desai, Krupali; Li, Qing; Chen, Jinbo; Langer, Corey; Mao, Jun J.

In: Journal of palliative medicine, Vol. 15, No. 8, 01.08.2012, p. 923-930.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Utilization of supportive and palliative care services among oncology outpatients at one academic cancer center

T2 - Determinants of use and barriers to access

AU - Kumar, Pallavi

AU - Casarett, David

AU - Corcoran, Amy

AU - Desai, Krupali

AU - Li, Qing

AU - Chen, Jinbo

AU - Langer, Corey

AU - Mao, Jun J.

PY - 2012/8/1

Y1 - 2012/8/1

N2 - Background: Cancer causes significant symptom burden and diminished quality of life. Despite the expansion of supportive and palliative care services (SPCS), little is known about rates of utilization and barriers to access to these services among oncology outpatients. Methods: We performed a cross-sectional survey in three outpatient medical oncology clinics. Patients with a diagnosis of breast, lung, or gastrointestinal (GI) cancer and a Karnofsky score of ≥60 were included. Patients reported their use of SPCS and any perceived barriers. Multivariable logistic regression was used to identify factors associated with SPCS use. Results: Among 313 participants, (50.5%) had not used SPCS since cancer diagnosis. The most common services used were nutrition (26.5%), psychiatric/psychological counseling (29.7%), and physical therapy (15.1%). Pain/palliative care and cancer rehabilitation consultations were used by 8.5% and 4.1% of participants, respectively. In multivariate analysis, graduate education was associated with greater SPCS use (adjusted odds ratio [AOR] 2.14, 95% confidence interval [CI] 1.08-4.26) compared with those with high school or less, whereas having lung cancer was associated with less SPCS use (AOR 0.48, 95% CI 0.24-0.96) when compared with those having breast cancer. The biggest reported barriers to using SPCS were a lack of awareness (22.4%) and lack of physician referral (23%). Conclusions: Approximately half of these patients had not accessed SPCS since cancer diagnosis and cite lack of awareness and physician nonreferral as barriers. Further research is needed to understand patients' needs and beliefs regarding SPCS, and how to integrate SPCS into conventional treatments to improve cancer care.

AB - Background: Cancer causes significant symptom burden and diminished quality of life. Despite the expansion of supportive and palliative care services (SPCS), little is known about rates of utilization and barriers to access to these services among oncology outpatients. Methods: We performed a cross-sectional survey in three outpatient medical oncology clinics. Patients with a diagnosis of breast, lung, or gastrointestinal (GI) cancer and a Karnofsky score of ≥60 were included. Patients reported their use of SPCS and any perceived barriers. Multivariable logistic regression was used to identify factors associated with SPCS use. Results: Among 313 participants, (50.5%) had not used SPCS since cancer diagnosis. The most common services used were nutrition (26.5%), psychiatric/psychological counseling (29.7%), and physical therapy (15.1%). Pain/palliative care and cancer rehabilitation consultations were used by 8.5% and 4.1% of participants, respectively. In multivariate analysis, graduate education was associated with greater SPCS use (adjusted odds ratio [AOR] 2.14, 95% confidence interval [CI] 1.08-4.26) compared with those with high school or less, whereas having lung cancer was associated with less SPCS use (AOR 0.48, 95% CI 0.24-0.96) when compared with those having breast cancer. The biggest reported barriers to using SPCS were a lack of awareness (22.4%) and lack of physician referral (23%). Conclusions: Approximately half of these patients had not accessed SPCS since cancer diagnosis and cite lack of awareness and physician nonreferral as barriers. Further research is needed to understand patients' needs and beliefs regarding SPCS, and how to integrate SPCS into conventional treatments to improve cancer care.

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