Impact of Patient and Caregiver Beliefs on Utilization of Hospice and Palliative Care in Diverse Patients With Advanced Lung Cancer

Objectives: To evaluate the impact of patient and caregiver hospice care (HC) and palliative care (PC) beliefs and patient/caregiver belief-agreement on subsequent utilization of HC/PC among racially and ethnically diverse patients. Methods: A prospective cohort study of newly diagnosed patients ≥18 years old with advanced lung cancer and their caregivers was conducted. Participants completed validated surveys at multiple points and electronic health records were reviewed to evaluate utilization. Logistic regression models were used: (i) to estimate the association between caregiver health belief composite scores and utilization of HC or PC; and (ii) to estimate the association between level of agreement between patient and caregivers, and utilization of HC or PC. Results: Among the 43 patient/caregiver dyads enrolled in the study, 27 (63%) identified as Black and/or Latino (minoritized) and 16 (37%) as Non-Hispanic White (non-minoritized). Mean age was 65.2 ± 10.2 and 52.1 ± 15.2 years among patients and caregivers, respectively. Minoritized patients held more negative health beliefs (2.7 ± 6.7 vs. 7.1 ± 4.9; p = 0.02) than their non-minoritized counterparts however, they were more likely to use HC and/or PC (67% vs. 25%; p = 0.02). Level of health belief agreement between patients and caregivers was lower in minoritized vs non-minoritized dyads (mean (SD) Kappa: 0.31 (0.18) vs. 0.18 (0.18); p < 0.01). Caregiver beliefs and patient/caregiver agreement in beliefs did not predict utilization of HC/PC. Conclusion: Minoritized lung cancer patients held more negative beliefs about HC/PC yet were more likely to receive HC/PC. Further work is needed to understand factors that impact utilization among diverse patients with advanced cancer.