Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
J Palliat Med. 2021 Dec;24(12):1833-1839. doi: 10.1089/jpm.2021.0114. Epub 2021 May 28.
Despite recent growth in access to specialty palliative care (PC) services, awareness of PC by patients and caregivers is limited and misconceptions about PC persist. Identifying gaps in PC knowledge may help inform initiatives that seek to reduce inequities in access to PC in rural areas. We compared knowledge of PC in metropolitan and nonmetropolitan areas of the United States using a nationally representative sample of U.S. adults. We used data from the 2018 Health Information National Trends Survey (HINTS) 5 Cycle 2 to compare prevalence and predictors of PC knowledge and misconceptions in nonmetropolitan and metropolitan areas as defined by the 2013 Urban-Rural Classification (URC) Scheme for Counties. We estimated the association between nonmetro status and knowledge of PC, adjusted for respondent characteristics, using multivariable logistic regression. More respondents reported that they had never heard of PC in nonmetro (78.8%) than metro (70.1%) areas ( < 0.05). Controlling for other factors, nonmetro residence was associated with a 41% lower odds of PC knowledge (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.37-0.94), and Hispanic respondents also demonstrated significantly lower odds of PC knowledge conditional on rural status (OR = 0.47; CI = 0.27-0.83). Misconceptions about PC were high in both metro and nonmetro areas. Awareness of PC was lower in rural and micropolitan areas compared with metropolitan areas, suggesting the need for tailored educational strategies. The reduced awareness of PC among Hispanic respondents regardless of rural status raises concerns about equitable access to PC services for this population.
尽管近年来获得专科姑息治疗 (PC) 服务的机会有所增加，但患者和护理人员对 PC 的认识有限，对 PC 的误解仍然存在。确定 PC 知识方面的差距可能有助于为旨在减少农村地区获得 PC 服务方面的不平等的举措提供信息。我们使用美国成年人的全国代表性样本，比较了美国大都市和非大都市地区对 PC 的认识。我们使用 2018 年健康信息国家趋势调查 (HINTS) 5 周期 2 的数据，根据 2013 年城市-农村分类 (URC) 方案，比较了大都市和非大都市地区 PC 知识和误解的流行率和预测因素。我们使用多变量逻辑回归，根据受访者特征，估计非大都市地位与 PC 知识之间的关联。更多的受访者报告说，他们从未听说过非大都市地区的 PC（78.8%）比大都市地区（70.1%）（<0.05）。在控制其他因素后，非大都市居住与 PC 知识的可能性降低 41%（优势比 [OR] = 0.59；95%置信区间 [CI] = 0.37-0.94），而西班牙裔受访者在农村地位的条件下也表现出 PC 知识的可能性明显降低（OR = 0.47；CI = 0.27-0.83）。大都市和非大都市地区对 PC 的误解都很高。与大都市地区相比，农村和小城市地区对 PC 的认识较低，这表明需要制定有针对性的教育策略。无论农村地位如何，西班牙裔受访者对 PC 的认识降低，这令人关切，因为这关系到为这一人群提供公平获得 PC 服务的机会。
