Exploring disparities in palliative care utilization among hospitalized patients with hepatocellular carcinoma: A retrospective cohort study.

Abstract

1616 Background: Hepatocellular carcinoma is one of the common gastrointestinal cancers, and its advanced stage requires palliative care due to its inferior prognosis and mortality. Palliative care significantly improves the burden of HCC on patients and the healthcare system. Despite the evidence of its use, reported utilization could have been better. This study aims to investigate the disparities in utilization of palliative care in hospitalized patients with HCC and examine related factors. Methods: This retrospective cohort study used data from the 2018-2020 National Inpatient Sample (NIS) database. Patients aged 18 or above with hepatocellular carcinoma were studied to determine how their utilization of palliative care varied based on their race and other identifiable risk factors. Palliative care utilization encompasses palliative care/ comfort care or under the care of a palliative care physician or referral. We examined these patients' demographics, All Patient Refined Diagnosis Related Group (APR-DRG) risk of mortality, and their relationship with palliative care utilization. Results: This study identified 128,140 patients with hepatocellular carcinoma (HCC), of whom 26,730 (20.9%) had utilized palliative care. The majority of study participants were White and male. The palliative care utilization (PCU) group comprised mainly White patients, with 50% of the group having extreme APR-DRG risk of mortality. Compared to Whites, Blacks had increased odds of palliative care utilization in both unadjusted (OR=1.08; 95% CI: 0.99-1.18) and adjusted models (aOR=1.11; 95% CI: 1.01-1.22). Hispanics had reduced odds in both unadjusted (OR=0.83; 95% CI: 0.75-0.91) and adjusted models (aOR=0.84; 95% CI: 0.76-0.93). Moreover, over 50% of study participants were in large, bed-sized hospitals and on Medicare insurance. Conclusions: Our study showed significant disparities in palliative care utilization among hospitalized patients with hepatocellular carcinoma. While the majority of patients were White and male, Black patients had increased odds of palliative care utilization, and Hispanics had reduced odds. Additionally, patients in large, bed-sized hospitals and on Medicare insurance comprised over 50% of the study population. The racial disparities in utilization might stem from differences in socio-cultural beliefs and practices alongside other factors. Efforts are needed to address these disparities and ensure equitable care for all patients, particularly vulnerable populations. Further research and quality improvement initiatives are essential to explore and address these disparities and contributing factors, enhancing outcomes for patients with HCC.