DeGroote Nicholas P, Allen Kristen E, Falk Erin E, Velozzi-Averhoff Cristina, Wasilewski-Masker Karen, Johnson Khaliah, Brock Katharine E
Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.
Department of Emergency Medicine, Columbia University, New York, NY, USA.
Support Care Cancer. 2022 Jan;30(1):923-930. doi: 10.1007/s00520-021-06500-6. Epub 2021 Aug 19.
Pediatric palliative care (PPC) improves quality of life for children and adolescents with cancer. Little is known about disparities between different racial and ethnic groups in the frequency and timing of PPC referrals. We evaluated the impact of race and ethnicity on the frequency and timing of PPC referral after initiation of an embedded PPO clinic where no formal consultation triggers exist.
Patients with cancer between 0 and 25 years at diagnosis who experienced a high-risk event between July 2015 and June 2018 were eligible. Demographic, disease, and PPC information were obtained. Descriptive statistics and logistic regression were used to assess likelihood of receiving PPC services by race/ethnicity.
Of 426 patients who experienced a high-risk event, 48% were non-Hispanic White, 31% were non-Hispanic Black, 15% were Hispanic of any race, and 4% were non-Hispanic Asian. No significant differences were found between race/ethnicity and age at diagnosis/death, sex, and diagnosis. PPC consultation (p = 0.03) differed by race. Non-Hispanic Black patients were 1.7 times more likely than non-Hispanic White patients to receive PPC after adjustment (p = 0.01). White patients spent less days in the hospital in the last 90 days of life (3.0 days) compared with Black (8.0), Asian (12.5), or Hispanic patients (14.0, p = 0.009) CONCLUSION: Disparities exist in patients receiving pediatric oncology and PPC services. Cultural tendencies as well as unconscious and cultural biases may affect PPC referral by race and ethnicity. Better understanding of cultural tendencies and biases may improve end-of-life outcomes for children and young adults with cancer.
儿科姑息治疗（PPC）可提高患有癌症的儿童和青少年的生活质量。对于不同种族和族裔群体在PPC转诊频率和时机方面的差异，人们了解甚少。我们评估了种族和族裔对在没有正式会诊触发因素的嵌入式PPO诊所启动后PPC转诊频率和时机的影响。
2015年7月至2018年6月期间诊断为癌症且经历高风险事件的0至25岁患者符合条件。获取了人口统计学、疾病和PPC信息。使用描述性统计和逻辑回归来评估按种族/族裔接受PPC服务的可能性。
在426例经历高风险事件的患者中，48%为非西班牙裔白人，31%为非西班牙裔黑人，15%为任何种族的西班牙裔，4%为非西班牙裔亚洲人。在种族/族裔与诊断/死亡年龄、性别和诊断之间未发现显著差异。PPC会诊（p = 0.03）因种族而异。调整后，非西班牙裔黑人患者接受PPC的可能性是非西班牙裔白人患者的1.7倍（p = 0.01）。与黑人（8.0天）、亚洲人（12.5天）或西班牙裔患者（14.0天，p = 0.009）相比，白人患者在生命的最后90天住院天数更少（3.0天）。结论：在接受儿科肿瘤学和PPC服务的患者中存在差异。文化倾向以及无意识和文化偏见可能会影响按种族和族裔进行的PPC转诊。更好地理解文化倾向和偏见可能会改善患有癌症的儿童和年轻人的临终结局。
