Factors associated with utilization of palliative care among hospitalized patients with cholangiocarcinoma.

Abstract

e24159 Background: Cholangiocarcinoma has a rising incidence and a low 5-year survival rate. Patients with this malignancy have a very high symptom burden, however, there are only a few studies reported on the prevalence of palliative care utilization in this population. This study examines the prevalence, sociodemographic, hospital-level, and patient-related factors associated with the utilization of palliative care among hospitalized patients with cholangiocarcinoma in the United States. Methods: Data from the National Inpatient Sample, 2016–2020, were used to conduct retrospective cohort analyses. Descriptive analyses were performed to evaluate the prevalence of palliative care consultations among hospitalized patients with a diagnosis of cholangiocarcinoma. Multivariable logistic regression models were used to examine the factors associated with the receipt of palliative care in this population. Results: Approximately 17.9% of our cohort received palliative care during their hospital stay. Cholangiocarcinoma patients aged 65 years and older were more likely to receive palliative care (AOR: 1.19; 95% CI: 1.06–1.32) compared to those less than 65 years. Female patients had 10% higher odds (95% CI: 1.02–1.18) of palliative care utilization relative to their male counterparts. Compared to patients on Medicare, those with Medicaid (AOR: 1.50; 95% CI: 1.29–1.75), private (AOR: 1.27; 95% CI: 1.13–1.42) or other insurance types (AOR: 2.31; 95% CI: 1.95–2.75) were more likely to receive palliative care during their hospital stay. While patients who had elective admissions were less likely (AOR: 0.45; 95% CI: 0.40–0.51) to utilize palliative care relative to those admitted non-electively, those admitted to urban teaching hospitals had 25% higher odds (AOR: 1.29; 95% CI: 1.06–1.57) of palliative care utilization when compared to patients admitted to rural hospitals. Additionally, hospitalized patients with a diagnosis of intrahepatic cholangiocarcinoma had 1.39 times higher odds (95% CI: 1.25–1.55) of receiving palliative care when compared to patients diagnosed with extrahepatic cholangiocarcinoma. Other factors associated with palliative care utilization were hospital region, Charlson comorbidity index and patient disposition. Conclusions: Palliative care consultations among hospitalized patients diagnosed with cholangiocarcinoma remain suboptimal. Our study highlights some of the sociodemographic and hospital-level barriers to the utilization of palliative care services which should guide healthcare providers on areas to improve upon with the goal of improving access to palliative care among hospitalized patients with cholangiocarcinoma.