RPD311 - Multilevel Factors Associated with Palliative Care Knowledge Among U.S. Adults with Multimorbidity

Key Message : Only 18% of U.S. adults with multimorbidity reported having adequate palliative care knowledge. The link between communication and knowledge depended on individuals’ trust in the healthcare system. Multilevel factors such as race, income, social support, discrimination, patient-centered communication, and digital skills should inform palliative care programs for individuals with multimorbidity.

Abstract:

Background: Knowledge of palliative care (PC) remains low nationwide (1,2). With the increasing prevalence of multimorbidity, defined as having two or more chronic conditions, gaps persist in understanding PC access and use, as well as factors associated with PC knowledge among this population (3).

Aim: Examine the multilevel factors associated with PC knowledge, stratified by trust in the healthcare system.

Methods: This cross-sectional study analyzed 2,168 U.S. adults (weighted=68,152,804) with multimorbidity from the 2024 Health Information National Trends Survey. The outcome was adequate PC knowledge. Using survey-weighted logistic regression, the study examined individual (age, gender, race/ethnicity, education, income), interpersonal (patient-centered communication (PCC), trust in healthcare system, experience of discrimination when receiving medical care), social (transportation, social support), and digital (digital search skills, patient portal access) factors associated with PC knowledge. Analyses were stratified by trust level in the healthcare system (low vs high).

Results: Only 18% of adults with multimorbidity reported having adequate PC knowledge. In the full sample, compared with non-Hispanic Whites, non-Hispanic Blacks (OR: 0.48; 95% CI: 0.29–0.80) reported lower odds, whereas having social support (OR: 2.43; 95% CI: 1.17–5.08), experiencing discrimination (OR: 2.26; 95% CI: 1.04–4.93), and having digital search skills (OR: 3.79; 95% CI: 1.65–8.70) were associated with higher odds of adequate PC knowledge. In the high-trust group, high income compared to low income (OR: 3.37; 95% CI: 1.26–9.01) and higher PCC (OR: 1.33 per 10-point increase; 95% CI: 1.03–1.70) were associated with higher odds of adequate PC knowledge. In the low-trust group, findings were consistent with the full-sample model, with PCC being insignificant.

Conclusions: PC knowledge remains low among individuals with multimorbidity. Multilevel factors (individual, interpersonal, social, and digital) relate to PC knowledge, with varying associations by trust in the system. Targeted strategies addressing these determinants may improve equitable access to and use of PC.

References: (1) Taber JM, Ellis EM, Reblin M, Ellington L, Ferrer RA. Knowledge of and beliefs about palliative care in a nationally-representative U.S. sample. PLoS One 2019;14(8):e0219074.
(2) Ogunsanya ME, Goetzinger EA, Owopetu OF, Chandler PD, O'Connor LE. Predictors of palliative care knowledge: findings from the Health Information National Trends Survey. Cancer Epidemiol Biomarkers Prev 2021;30(7):1433-1439.
(3) Llop-Medina L, Fu Y, Garcés-Ferrer J, Doñate-Martínez A. Palliative care in older people with multimorbidities: a scoping review on the palliative care needs of patients, carers, and health professionals. Int J Environ Res Public Health 2022;19(6):3