A Retrospective Analysis of Palliative Care Consultations and Racial Disparities Among Adults in an Intensive Care Unit (Sch407)

• Published in: Journal of pain and symptom management 2023-05, Vol.65 (5), p.e582-e582
• Main Authors: Ejem, Stacy, MD MS, Wells, Rachel D., PhD RN, Wagner, Courtney, MD, Ejem, Deborah, PhD, Bakitas, Marie, DNSc CRNP, Iyer, Anand, MD MSPH
• Format: Article
• Language: English
• Subjects: Anesthesia; Pain Medicine
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2023.02.144

Outcomes1. Recognize the underutilization of palliative care consultations in critically ill adults and those with palliative care consults are less likely to receive invasive procedures. 2. Understand that racial disparities exist in palliative care consultations frequency and symptom management recommendations. Original research backgroundPalliative care (PC) is often underutilized among critically ill adults, and racial disparities exist at the end of life. Research objectives(1) Examine differences in characteristics among critically ill adults who did and did not have specialist PC consults. (2) Among decedents, compare differences in invasive treatments and explore differences in PC consult characteristics and PC recommendations by race. MethodsRetrospective chart review of a cohort of adults admitted to the MICU between 2014 and 2019 who did and did not have a PC consult. In a decedent subset who received PC consultation, we conducted a content analysis of consult characteristics and compared consult characteristics by race. ResultsA total of 1,536 patients were included in the cohort (mean age: 58.6±16.0 years, 37% black, and 50% female). Those with PC consults (n=242; 15%) were older (p< 0.001) and more likely to be white (p=0.029). Among decedents (n=1,294), those who had PC consult (n=220; 17%) were less likely to have vasopressors (p=0.001), central venous lines (p=0.041), arterial lines (p=0.01), and more likely to receive opioids (p=0.001) and mechanical ventilation (p=0.014). Black decedents with PC consults (n=73; 38%), compared to white decedents (n=113; 59%), had shorter initial PC consult length (p=0.046) and were less likely to have general symptom management evaluation (p=0.009) and to have recommendations for anxiety (p=0.001), depression (p=0.045), and constipation (p=0.007). ConclusionOnly one in seven critically ill adults in our cohort had PC consults, and those with PC consults were less likely to receive invasive procedures. Black individuals were less likely to have PC consultation and, among decedents, had PC consults with symptom management recommendations. Implications for research, policy, or practicePC consultation remains underutilized in the ICU. Addressing racial disparities in PC consultation frequency and recommendations is crucial to ensuring equitable care for this seriously ill population.