Journal of pain and symptom management · 2026
Palliative Care and EOL Care Utilization in Hospitalized Adults of Dharmic Religions With Cancer.
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Patel Rushil V, Bowden Jill M, Boselli Danielle, Strahley Ashley E, Gibbs Sydney-Evelyn L, Murali Komal P, Patel Viraj R, Patel Adarsh, Kotecha Ritesh R, Nelson Judith E
Аннотация
CONTEXT: Palliative care (PC) and end-of-life (EOL) care utilization for adults of dharmic religions (DR; Hinduism, Buddhism, Sikhism, and Jainism) with cancer in the US is unknown.
OBJECTIVES: To measure PC utilization and EOL outcomes among hospitalized DR adults with cancer METHODS: We reviewed electronic health record (EHR) data for PC utilization and National Quality Framework (NQF)-endorsed EOL metrics at a dedicated cancer hospital and interviewed hospitalized DR patients and chaplains.
RESULTS: Of 54,828 hospitalized adults, DR individuals (2.1% of study population) had higher PC utilization compared to non-DR (NDR) individuals (14.6% vs. 11.8%; P = 0.004). In multivariate analysis, advanced illness (OR 18.57) was the strongest predictor of PC utilization. Compared to NDR individuals, DR individuals had higher inpatient deaths (27% vs. 12%; P < 0.001), hospice enrollment ≤3 days before death (5% vs. 2%; P = 0.021), chemotherapy use ≤ 14 days before death (11% vs. 8%; P < 0.001), and ICU care ≤ 30 days before death (12% vs. 5%; P < 0.001). Qualitative findings highlighted DR preferences for Ayurveda and dietary practices, the role of beliefs in coping with a cancer diagnosis, inconsistent communication of EOL preferences, and opportunities to improve care.
CONCLUSION: For DR adults with cancer, PC is triggered by higher acute care utilization at the EOL. Interviews uncovered unmet socio-cultural needs. To improve outcomes, medical oncology and PC teams need to proactively address values across the cancer trajectory.
OBJECTIVES: To measure PC utilization and EOL outcomes among hospitalized DR adults with cancer METHODS: We reviewed electronic health record (EHR) data for PC utilization and National Quality Framework (NQF)-endorsed EOL metrics at a dedicated cancer hospital and interviewed hospitalized DR patients and chaplains.
RESULTS: Of 54,828 hospitalized adults, DR individuals (2.1% of study population) had higher PC utilization compared to non-DR (NDR) individuals (14.6% vs. 11.8%; P = 0.004). In multivariate analysis, advanced illness (OR 18.57) was the strongest predictor of PC utilization. Compared to NDR individuals, DR individuals had higher inpatient deaths (27% vs. 12%; P < 0.001), hospice enrollment ≤3 days before death (5% vs. 2%; P = 0.021), chemotherapy use ≤ 14 days before death (11% vs. 8%; P < 0.001), and ICU care ≤ 30 days before death (12% vs. 5%; P < 0.001). Qualitative findings highlighted DR preferences for Ayurveda and dietary practices, the role of beliefs in coping with a cancer diagnosis, inconsistent communication of EOL preferences, and opportunities to improve care.
CONCLUSION: For DR adults with cancer, PC is triggered by higher acute care utilization at the EOL. Interviews uncovered unmet socio-cultural needs. To improve outcomes, medical oncology and PC teams need to proactively address values across the cancer trajectory.