Exploring Barriers to Palliative Care Utilization in the Outpatient Setting

• Dionna Lee, Biological Sciences, Delaware State University

• Zugui Zhang, Christiana Care, n/a
• Sarah Matthews, Chrisitana Care, n/a
• Patricia Pawlow, Christiana Care, n/a

This report evaluates factors associated with completion of an initial outpatient palliative care (PC) appointment after referral. The primary comparison is between patients who completed the initial appointment and patients who did not complete it, using the verified appointment-completion field as the outcome. The analysis is intentionally described as an association study, not a causal study. The available dataset includes patient demographic variables and selected referral-system variables, but it does not include several potentially important barriers such as insurance, transportation, diagnosis, disease severity, hospitalization, scheduling delay, referral urgency, patient refusal, or reason for noncompletion.

Outpatient palliative care may improve symptom management, communication, advance care planning, caregiver support, and care coordination. However, referral does not guarantee that a patient will successfully complete an initial appointment. Patient-level and health-system barriers may affect access and utilization. The main question for this research is, among patients referred to outpatient palliative care, which patient and system factors are associated with failure to complete the initial palliative care appointment, compared with successful completion? The hypothesis was that multiple patient-level and system-level barriers are associated with noncompletion of the initial outpatient palliative care appointment. To support this hypothesis a retrospective observational cohort study of outpatient palliative care referrals represented in the supplied dataset was used. A substantial portion of patients referred to outpatient palliative care may not complete an initial appointment. The present analysis identifies demographic and available system-level characteristics associated with noncompletion, while recognizing that the dataset cannot fully explain why noncompletion occurred. The findings should guide more detailed data collection and targeted quality-improvement strategies aimed at reducing modifiable barriers to palliative care access.