Palliative Care and EOL Care Utilization in Hospitalized Adults of Dharmic Religions with Cancer.

CONTEXT: Palliative care (PC) and end-of-life (EOL) care utilization for adults of Dharmic religions (DR; Hinduism, Buddhism, Sikhism, and Jainism) with cancer in the US is unknown. OBJECTIVES: To measure PC utilization and EOL outcomes among hospitalized DR adults with cancer METHODS: We reviewed electronic health record (EHR) data for PC utilization and National Quality Framework (NQF)-endorsed EOL metrics at a dedicated cancer hospital and interviewed hospitalized DR patients and chaplains. RESULTS: Of 54,828 hospitalized adults, DR individuals (2.1% of study population) had higher PC utilization compared to non-DR (NDR) individuals (14.6% vs. 11.8%; p=0.004). In multivariate analysis, advanced illness (OR 18.57) was the strongest predictor of PC utilization. Compared to NDR individuals, DR individuals had higher inpatient deaths (27% vs 12%; p <.001), hospice enrollment ≤ 3 days before death (5% vs 2%; p = .021), chemotherapy use ≤ 14 days before death (11% vs 8%; p<.001), and ICU care ≤ 30 days before death (12% vs 5%; p<.001). Qualitative findings highlighted DR preferences for Ayurveda and dietary practices, the role of beliefs in coping with a cancer diagnosis, inconsistent communication of EOL preferences, and opportunities to improve care. CONCLUSION: For DR adults with cancer, PC is triggered by higher acute care utilization at the EOL. Interviews uncovered unmet socio-cultural needs. To improve outcomes, medical oncology and PC teams need to proactively address values across the cancer trajectory.