Modifiers of and Disparities in Palliative and Supportive Care Timing and Utilization among Neurosurgical Patients with Malignant Central Nervous System Tumors

SIMPLE SUMMARY: Guidelines recommend early initiation of palliative care (PC) for patients with advanced cancers. Central nervous system (CNS) malignancies pose particular challenges for patients, who benefit from supportive care services such as PC, home health, and social work support. We analyze a cohort of privately insured patients with malignant brain or spinal tumors from the Optum Clinformatics Datamart Database to investigate health disparities in supportive care service access and utilization. We introduce a novel construct, “provider patient racial diversity index” (provider pRDI), the proportion of non-white minority patients a provider encounters to approximate a provider’s patient demographics and suggest a provider’s exposure to diversity. Our manuscript adds to existing literature on patient-level health disparities and provides a platform for future research focused on provider-level quality improvement interventions for utilization of supportive care services. ABSTRACT: Patients with primary or secondary central nervous system (CNS) malignancies benefit from utilization of palliative care (PC) in addition to other supportive services, such as home health and social work. Guidelines propose early initiation of PC for patients with advanced cancers. We analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities in access to and utilization of supportive services. We introduce a novel construct, “provider patient racial diversity index” (provider pRDI), which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider’s patient demographics and suggest a provider’s cultural sensitivity and exposure to diversity. Our analysis demonstrates low rates of PC, home health, and social work services among racial minority patients. Notably, Hispanic patients had low likelihood of engaging with all three categories of supportive services. However, patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses. This study suggests that prospective studies that examine potential interventions at the provider level, including diversity training, are needed.