RPD207 - Social Determinants of Health and Domains of Care Addressed during Pediatric Palliative Care Visits

Key Message : Although disparities exist in pediatric palliative care (PPC) by social determinants of health, domains of care addressed in PPC visits were similar across patient race/ethnicity, social deprivation index score, primary language, and patient/clinician race concordance. Disparities likely emerge from a more complex interplay of variables.

Abstract:

Background: Pediatric palliative care (PPC) improves symptom management and end-of-life (EOL) outcomes, yet sociodemographic disparities exist in PPC and EOL care (1,2).

Objective: To evaluate associations between subdomains of care addressed during PPC visits of children with cancer and social determinants of health (SDOH).

Methods: This retrospective cohort study included patients 0-27 years old with cancer receiving PPC between 2017-2022. After each visit, the clinician selected domains of care (Goals of Care, Symptom Management, and Care Coordination) addressed with respective subdomains. Differences in frequency of subdomains addressed were compared using Kruskal-Wallis tests across SDOH, including race/ethnicity, social deprivation index (SDI) score, and language.

Results: Among 467 patients, there were 7,548 PPC visits with a median of 10 (IQR 4,21) visits per patient. Most patients were English-speaking (n=425, 92.0%), non-Hispanic (n=384, 82.2%), and identified as White (n=270, 57.8%) or Black (n=166, 35.50%), with a median age of 10.4 years at diagnosis. Eight (IQR 7,11) subdomains were addressed per visit, including 4 Goals of Care, 3 Symptom Management, and 2 Care Coordination subdomains. Slightly more subdomains were addressed in Non-Hispanic White visits (9, IQR 7,11) compared to other races/ethnicities (8, p< 0.001). There was no clear correlation between SDI and subdomains addressed [median 8 vs 9 vs 8, for low, intermediate and high SDI groups respectively (IQR 7,11 for all) (p=0.092)]. English (IQR 7,11) and non-English speaking (IQR 7,10) visits addressed a clinically similar median of 8 subdomains (p < 0.001). Slightly more subdomains were addressed in patient/clinician race-discordant (9, IQR 7,11) than race-concordant encounters (8, IQR 7,10) (p < 0.001).

Conclusions: While care outcomes (ex: hospice utilization) differ by SDOH, frequencies of subdomains discussed during PPC visits were similar. Disparities in PPC and EOL outcomes likely emerge from a complex interplay of variables beyond visit content, including health literacy, patient preference, historical context, and systemic factors.

References: 1. Boyden JY, Curley MAQ, Deatrick JA, Ersek M. Factors Associated with the Use of U.S. Community–Based Palliative Care for Children with Life-Limiting or Life-Threatening Illnesses and Their Families: An Integrative Review. Journal of Pain and Symptom Management. 2018;55(1):117-131. doi:10.1016/j.jpainsymman.2017.04.017
2. Linton JM, Feudtner C. What Accounts for Differences or Disparities in Pediatric Palliative and End-of-Life Care? A Systematic Review Focusing on Possible Multilevel Mechanisms. Pediatrics. 2008;122(3):574-582. doi:10.1542/peds.2007-3042