First Hospital-Based Pain and Palliative Care Program in Hawaii

1.Examine ethnic variations in referral to a hospital-based pain and palliative care service.2.Examine ethnic variations in outcomes of a hospital-based pain and palliative care service. I. Background. Although studies have reported ethnic variations in hospice utilization and pain management, data is limited on ethnicity and outcomes of hospital-based palliative care. II. Aim. To examine ethnic variations in referral and outcomes of pain and palliative care consultations in Hawaii III. Method/Session Description: This study analyzed data collected by the Pain and Palliative Care Department at The Queen's Medical Center in Honolulu, Hawaii. All patients receiving pain and palliative care consultations from 1/1/2005 to 12/31/2008 were included. Patient demographic data, diagnosis, referral indication (pain, symptoms, plan of care, or a combination), and outcomes of referral (code status, hospice referral, and discharge disposition) were examined. Symptom scores (pain, nausea, dyspnea, constipation, depression, confusion, and anxiety) were measured using a four-point scale at the time of consultation and prior to discharge. From 1/1/2005 to 12/31/2008, 4,611 patients received consultations. The study population was 43% white, 18% Japanese ethnicity, 14% part-Hawaiian, and 25% multiple other ethnicities. The Japanese ethnicity group was older than the other ethnicities (mean age 66.5 vs. 52–58 years, P < .0001). Compared to the Japanese, Hawaiian, and other ethnic groups, more white patients had orthopedic diagnoses (30% vs. 18% to 27%, P < .0001), fewer had cancer diagnoses (19% vs. 33% to 37%, P < .0001), and more were referred for pain consultation only (80% vs. 72% to 73%, P < .0001). More nonwhite patients had code status changed to “Do not attempt resuscitation” (7% to 8% vs. 3%, P < .0001), referrals to hospice (11.5% to 15% vs. 7%, P < .0001), and end-of-life care in the hospital (16% to 27% vs. 8%, P < .0001). All ethnic groups demonstrated significant reductions in pain and symptoms. IV. Conclusion. Patients receiving consultations demonstrated significant reductions in pain and symptoms. Ethnic variations in pain and palliative care consultations were demonstrated. More non-white patients than white patients had cancer and end-of-life care. Further study may clarify reasons for these ethnic variations. Structure and Processes of Care; Cultural Aspects of Care